Healthcare utilisation and expenditure patterns for cardio-metabolic diseases in South Asian cities: the CARRS Study
Objective To estimate average annual expenditures per person, total economic burden and distress health financing associated with the treatment of five cardio-metabolic diseases (CMDs—hypertension, diabetes, heart disease (angina, myocardial infarction and heart failure), stroke and chronic kidney d...
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e036317.full |
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| author | Dorairaj Prabhakaran Kavita Singh Roopa Shivashankar Nikhil Tandon Mohammed K Ali Kalpana Singh V Mohan Priti Gupta Ajay Vamadevan Muhammad Masood Kadir K M Narayan |
| author_facet | Dorairaj Prabhakaran Kavita Singh Roopa Shivashankar Nikhil Tandon Mohammed K Ali Kalpana Singh V Mohan Priti Gupta Ajay Vamadevan Muhammad Masood Kadir K M Narayan |
| author_sort | Dorairaj Prabhakaran |
| collection | DOAJ |
| description | Objective To estimate average annual expenditures per person, total economic burden and distress health financing associated with the treatment of five cardio-metabolic diseases (CMDs—hypertension, diabetes, heart disease (angina, myocardial infarction and heart failure), stroke and chronic kidney disease) in three metropolitan cities in South Asia.Design Cross-sectional surveys.Setting We analysed community-based baseline data from the Centre for cArdio-metabolic Risk Reduction in South Asia (CARRS) Study collected in 2010–2011 representing Chennai and New Delhi (India), and Karachi (Pakistan).Participants We used data from non-pregnant adults (≥20 years) from the aforementioned cities that responded to a cost-of-illness questionnaire. We estimated health utilisation and expenditures among those reporting taking treatment(s) for the aforementioned CMDs in the last 1 year. We converted all costs to International Dollars (Int$ 2011) and inflated to 2018 values. The annual costs per person were stratified by city, sociodemographic characteristics, contributor of costs and financing methods. The total economic burden of CMDs for each city was projected using age-standardised prevalence and per-person costs of diseases reported in CARRS, applying these to population data from the most recent census. We also calculated distress financing (DF) as having to borrow or sell assets to pay for CMD treatment and identified sociodemographic groups at most risk of DF using multiple regression.Results Of 16 287 CARRS participants, 2883 (17.7%) reported receiving treatment for CMDs. The total annual expenditures reported per patient for CMDs ranged from Int$358 to Int$2425. Medications constituted 46% of total direct expenditures and out-of-pocket (OOP) expenditures accounted for nearly 80% of financing these health expenditures. Total economic burdens of CMDs were Int$0.42 billion, Int$3.4 billion and Int$1.4 billion in Chennai, New Delhi and Karachi, respectively. Overall, 36.1% experienced DF, and women (OR=4.4), unemployed (OR=10.7) and uninsured (OR=8.1) adults experienced higher odds of DF.Conclusion CMDs are associated with large economic burdens in South Asia. Due to most payments coming from OOP expenditures and limited insurance, the odds of DF are high. |
| format | Article |
| id | doaj-art-30ff4f76ed044822832e67083f871bdf |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-30ff4f76ed044822832e67083f871bdf2025-01-08T08:35:09ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2019-036317Healthcare utilisation and expenditure patterns for cardio-metabolic diseases in South Asian cities: the CARRS StudyDorairaj Prabhakaran0Kavita Singh1Roopa Shivashankar2Nikhil Tandon3Mohammed K Ali4Kalpana Singh5V Mohan6Priti Gupta7Ajay Vamadevan8Muhammad Masood Kadir9K M Narayan10The Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, New Delhi, India1 Pan-Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UKCentre for Chronic Disease Control, Gurgaon, Haryana, IndiaDepartment of Endocrinology, All India Institute of Medical Sciences, New Delhi, IndiaRollins School of Public Health, Atlanta, Georgia, USAClinical Trials Unit, Centre for Chronic Disease Control, New Delhi, Delhi, IndiaMadras Diabetes Research Foundation, Chennai, IndiaCentre for Chronic Disease Control, New Delhi, IndiaCentre for Chronic Disease Control, New Delhi, India1 Department of Community Health Sciences, Aga Khan University, Karachi, PakistanGlobal Health, Emory University School of Public Health, Atlanta, Georgia, USAObjective To estimate average annual expenditures per person, total economic burden and distress health financing associated with the treatment of five cardio-metabolic diseases (CMDs—hypertension, diabetes, heart disease (angina, myocardial infarction and heart failure), stroke and chronic kidney disease) in three metropolitan cities in South Asia.Design Cross-sectional surveys.Setting We analysed community-based baseline data from the Centre for cArdio-metabolic Risk Reduction in South Asia (CARRS) Study collected in 2010–2011 representing Chennai and New Delhi (India), and Karachi (Pakistan).Participants We used data from non-pregnant adults (≥20 years) from the aforementioned cities that responded to a cost-of-illness questionnaire. We estimated health utilisation and expenditures among those reporting taking treatment(s) for the aforementioned CMDs in the last 1 year. We converted all costs to International Dollars (Int$ 2011) and inflated to 2018 values. The annual costs per person were stratified by city, sociodemographic characteristics, contributor of costs and financing methods. The total economic burden of CMDs for each city was projected using age-standardised prevalence and per-person costs of diseases reported in CARRS, applying these to population data from the most recent census. We also calculated distress financing (DF) as having to borrow or sell assets to pay for CMD treatment and identified sociodemographic groups at most risk of DF using multiple regression.Results Of 16 287 CARRS participants, 2883 (17.7%) reported receiving treatment for CMDs. The total annual expenditures reported per patient for CMDs ranged from Int$358 to Int$2425. Medications constituted 46% of total direct expenditures and out-of-pocket (OOP) expenditures accounted for nearly 80% of financing these health expenditures. Total economic burdens of CMDs were Int$0.42 billion, Int$3.4 billion and Int$1.4 billion in Chennai, New Delhi and Karachi, respectively. Overall, 36.1% experienced DF, and women (OR=4.4), unemployed (OR=10.7) and uninsured (OR=8.1) adults experienced higher odds of DF.Conclusion CMDs are associated with large economic burdens in South Asia. Due to most payments coming from OOP expenditures and limited insurance, the odds of DF are high.https://bmjopen.bmj.com/content/10/9/e036317.full |
| spellingShingle | Dorairaj Prabhakaran Kavita Singh Roopa Shivashankar Nikhil Tandon Mohammed K Ali Kalpana Singh V Mohan Priti Gupta Ajay Vamadevan Muhammad Masood Kadir K M Narayan Healthcare utilisation and expenditure patterns for cardio-metabolic diseases in South Asian cities: the CARRS Study BMJ Open |
| title | Healthcare utilisation and expenditure patterns for cardio-metabolic diseases in South Asian cities: the CARRS Study |
| title_full | Healthcare utilisation and expenditure patterns for cardio-metabolic diseases in South Asian cities: the CARRS Study |
| title_fullStr | Healthcare utilisation and expenditure patterns for cardio-metabolic diseases in South Asian cities: the CARRS Study |
| title_full_unstemmed | Healthcare utilisation and expenditure patterns for cardio-metabolic diseases in South Asian cities: the CARRS Study |
| title_short | Healthcare utilisation and expenditure patterns for cardio-metabolic diseases in South Asian cities: the CARRS Study |
| title_sort | healthcare utilisation and expenditure patterns for cardio metabolic diseases in south asian cities the carrs study |
| url | https://bmjopen.bmj.com/content/10/9/e036317.full |
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