Cost of care and its impact on households due to lymphatic filariasis: Analysis of a national sample survey in India

Abstract

Background and objectives: India is an endemic country for lymphatic filariasis (LF). There are no current estimates of the expenditure being borne by LF patients in case of outpatient care or hospitalisation and its impact on households. This study aimed to estimate the household out-of-pocket (OOP) expenditure due to hospitalization or outpatient care as a result of LF in India. Methods: Secondary analysis of nationally representative data for India collected by the National Sample Survey Organization in 2014 was performed, reporting on health service utilization and health care related OOP expenditure by income quintiles and by type of health facility (public or private). Results: The median household OOP expenditure from hospitalization and outpatient care due to LF was US$ 178 and US$ 04, respectively; and was more than two times higher among the richest group compared to the poorest. There was a significantly higher proportion of households affected by catastrophic costs among the rich (30%) compared to the poor households (18%) due to hospitalization. Median private sector OOP hospitalization expenditure was nearly four times higher than the public sector. Less than one-fourth of outpatient visits (22%) were in the public sector. The median expenditure on medicines and indirect cost were US$ 32 (IQR: 17–84) and US$ 23 (IQR: 9–59), respectively in case of hospitalization due to LF; while in case of outpatient care these were US$ 1.5 (IQR: 0–5.8) and US$ 1.5 (IQR: 0–4), respectively. Interpretation & conclusion: Households with LF incur huge cost of patient care, particularly those in the lowest income group and those seeking care in the private sector.

Keywords

• catastrophic expenditure; economic burden; india; lymphatic filariasis; out-of-pocket expenditure