TREND OF CONGENITAL HEART DISEASE AMONG CHILDREN IN INDONESIA WITHIN UNIVERSAL HEALTH COVERAGE: A 5-YEAR NATIONWIDE CLAIMS-BASED STUDY
Author(s)
Gassani Amalia, MD, MSc1, Pribadi Wiranda Busro, MD, PhD2, Adhinata Mohammad Yudho Negoro, student1, Jenni Pratita, MD, MSc2.
1Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, 2Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
1Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, 2Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
OBJECTIVES: Although BPJS-Kesehatan, Indonesia's public insurer, covers 80% population, pediatric congenital heart disease (CHD) care under universal coverage remains uncharacterized nationally. This study describes trends in treated CHD prevalence, costs, healthcare utilisation, in-hospital mortality, and geographic distribution, among BPJS-enrolled children.
METHODS: We conducted a retrospective cross-sectional analysis of anonymised BPJS-Kesehatan national claims (2020-2024), using survey-weighted analysis to account for complex sampling design. Children aged <18 years with ≥1 claim carrying ICD-10 codes Q20-Q26 as a primary or secondary diagnosis were identified at encounter level; patient-level estimates used each patient's first annual encounter. Prevalence and distribution were assessed across the full cohort; costs, utilisation, and mortality were assessed among CHD-primary encounters. All analyses were stratified by severity.
RESULTS: A total of 7,372 sample projected to 218,954 treated children (1,922,765 encounters). Treated prevalence more than doubled, from 77.7 to 165.4 per 100,000 (period prevalence 436.9), driven by rising non-critical CHD cases (62.7% to 80.7%). Most patients were aged <1 year (53.1%). Hospitalisation declined from 42% to 24%. Direct cost rose from US$19.5M (2020) to a 2023 peak (US$46.2M) before falling to US$34.6M in 2024 (5-year total US$182.8M; 87% inpatient). Critical CHD (12.3% of patients) accounted for 21% of cost and higher hospitalisation (74% vs 27%) than non-critical disease. CHD-treating hospitals rose from 16 to 21, concentrated in Java (65% of cases) despite prevalence varying 13-fold across provinces. Mortality was low in Java (2-8%) but reached 30-79% elsewhere.
CONCLUSIONS: Pediatric CHD burden increased in Indonesia, driven by rising non-critical cases, with critical CHD contributing disproportionately, alongside persistent geographic inequities. These findings indicate a need to expand capacity from case volume toward integrated complex and critical care pathways, supported by strengthened early detection, regionalised cardiac services, sustainable financing, multistakeholder monitoring, and a comprehensive registry to overcome claims-based unspecified coding, together informing evidence-driven strategies toward equitable care.
METHODS: We conducted a retrospective cross-sectional analysis of anonymised BPJS-Kesehatan national claims (2020-2024), using survey-weighted analysis to account for complex sampling design. Children aged <18 years with ≥1 claim carrying ICD-10 codes Q20-Q26 as a primary or secondary diagnosis were identified at encounter level; patient-level estimates used each patient's first annual encounter. Prevalence and distribution were assessed across the full cohort; costs, utilisation, and mortality were assessed among CHD-primary encounters. All analyses were stratified by severity.
RESULTS: A total of 7,372 sample projected to 218,954 treated children (1,922,765 encounters). Treated prevalence more than doubled, from 77.7 to 165.4 per 100,000 (period prevalence 436.9), driven by rising non-critical CHD cases (62.7% to 80.7%). Most patients were aged <1 year (53.1%). Hospitalisation declined from 42% to 24%. Direct cost rose from US$19.5M (2020) to a 2023 peak (US$46.2M) before falling to US$34.6M in 2024 (5-year total US$182.8M; 87% inpatient). Critical CHD (12.3% of patients) accounted for 21% of cost and higher hospitalisation (74% vs 27%) than non-critical disease. CHD-treating hospitals rose from 16 to 21, concentrated in Java (65% of cases) despite prevalence varying 13-fold across provinces. Mortality was low in Java (2-8%) but reached 30-79% elsewhere.
CONCLUSIONS: Pediatric CHD burden increased in Indonesia, driven by rising non-critical cases, with critical CHD contributing disproportionately, alongside persistent geographic inequities. These findings indicate a need to expand capacity from case volume toward integrated complex and critical care pathways, supported by strengthened early detection, regionalised cardiac services, sustainable financing, multistakeholder monitoring, and a comprehensive registry to overcome claims-based unspecified coding, together informing evidence-driven strategies toward equitable care.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD137
Topic
Economic Evaluation, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Pediatrics