Prinja Shankar, Bahuguna Pankaj, Duseja Ajay, Kaur Manmeet, Chawla Yogesh Kumar
School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Pharmacoecon Open. 2018 Jun;2(2):179-190. doi: 10.1007/s41669-017-0041-4.
Liver diseases contribute significantly to the health and economic burden globally. We undertook this study to assess the health system costs, out-of-pocket (OOP) expenditure and extent of financial risk protection associated with treatment of liver disorders in a tertiary care public sector hospital in India.
The present study was undertaken in an intensive care unit (ICU) of a tertiary care hospital in North India. It comprised an ICU and an HDU (high dependency unit). Bottom-up micro-costing was undertaken to assess the health system costs. Data on OOP expenditure and indirect costs were collected for 150 liver disorder patients admitted to the ICU or HDU from December 2013 to October 2014. Per-patient and per-bed-day costs of treatment were estimated from both health system and patient perspectives. Financial risk protection was assessed by computing prevalence of catastrophic health expenditure as a result of OOP expenditure.
In 2013-2014, health system costs per patient treated in the ICU and HDU were US$2728 [Indian National Rupee (INR) 1,63,664] and US$1966 (INR 1,17,985), respectively. The mean OOP expenditures for treatment in the ICU and HDU were US$2372 (INR 1,42,297) and US$1752 (INR 1,05,093), respectively. Indirect costs of hospitalization in ICU and HDU patients were US$166 (INR 9952) and US$182 (INR 10,903), respectively.
Treatment of chronic liver disorders poses an economic challenge for both the health system and patients. There is a need to focus on prevention of liver disorders, and finding ways to treat patients without exposing their households to the catastrophic effect of OOP expenditure.
肝脏疾病在全球范围内对健康和经济负担造成了重大影响。我们开展这项研究，以评估印度一家三级医疗公立部门医院中与肝脏疾病治疗相关的卫生系统成本、自付费用以及财务风险保护程度。
本研究在印度北部一家三级医疗医院的重症监护病房（ICU）进行。该病房包括一个ICU和一个高依赖病房（HDU）。采用自下而上的微观成本核算方法来评估卫生系统成本。收集了2013年12月至2014年10月期间入住ICU或HDU的150例肝脏疾病患者的自付费用和间接成本数据。从卫生系统和患者两个角度估算了每位患者的治疗成本和每日床位成本。通过计算因自付费用导致的灾难性卫生支出患病率来评估财务风险保护情况。
2013 - 2014年，在ICU和HDU接受治疗的每位患者的卫生系统成本分别为2728美元（163,664印度卢比）和1966美元（117,985印度卢比）。在ICU和HDU接受治疗的平均自付费用分别为2372美元（142,297印度卢比）和1752美元（105,093印度卢比）。ICU和HDU患者的住院间接成本分别为166美元（9952印度卢比）和182美元（10,903印度卢比）。
慢性肝脏疾病的治疗对卫生系统和患者都构成了经济挑战。有必要关注肝脏疾病的预防，并找到在不使患者家庭承受自付费用灾难性影响的情况下治疗患者的方法。
