This type of costs is directly attributable to patients admitted to various types of health care facilities (Ministry of Health, Social Security, and private sector), as well as treatment costs, including different services, such as diagnostic, medical, and rehabilitation services [26]. To estimate direct costs, the costs of standard diagnostic services, such as electrocardiograms, echocardiography, exercise testing, nuclear heart scan, and angiography, were included. Sampling was performed among patients who had undergone open-heart surgery, angioplasty, and medication. Sample sizes for the three groups (undergone open-heart surgery, angioplasty, and medication) were 135, 251, and 221 people, respectively. Sampling was performed using simple random sampling method and Cochrane-Orcutt Procedure, which is applicable for a limited population, was used. The main drugs for CVDs were also extracted by reviewing 65 patients’ medical records and interviews with CVDs specialists. In this section, direct payments were considered as the patients’ OOP expenditure, which can be due to the difference between the patient’s share of the cost and share of the insurance cost, which was recorded as the patient’s share of the costs in their medical record.

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