Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Richard A. and Susan F. Smith Center for Outcomes Research, 375 Longwood Ave, 4th Floor, Boston, MA, USA.
Indian Heart J. 2021 Mar-Apr;73(2):169-173. doi: 10.1016/j.ihj.2020.11.151. Epub 2020 Dec 7.
Costs can be a major barrier to medication adherence in low and middle-income countries and are an important target for policy-level interventions. The use of benzathine penicillin G (BPG) for secondary prevention of rheumatic heart disease (RHD) averts substantial morbidity and mortality, yet the total out-of-pocket costs for patients receiving this intervention are unknown.
To estimate the total out-of-pocket costs for obtaining BPG prophylaxis among RHD patients in India.
We prospectively collected self-reported drug-, transportation-, and provider-related costs for secondary prophylaxis among RHD patients presenting for follow-up to a tertiary care centre in New Delhi, India. Monthly costs were estimated by adjusting unit costs by frequency of drug administration.
The cost data provided by 420 patients [mean age (±SD) 11.6 (±2.9) years] was analysed. Majority of the patients were male (65.2%), hailed from rural areas (87.1%), and belonged to lower socioeconomic strata (73.3%). The median monthly total out-of-pocket costs (IQR) for obtaining BPG injections was Indian rupee (INR) 62.5 (42.5-117.0). The median costs for procuring the drug (IQR) was INR 34.0(30.0-39.0). Whereas median costs (IQR) for health care provider and transportation was INR 16.0 [0-32.0]) and INR 11 [0-31.0] respectively. When expressed as mean (SD), the costs for transportation constituted 50% of the total costs, whereas the mean cost for drug procurement and drug administration constituted 30% and 22% of the total costs respectively.
RHD patients receiving BPG prophylaxis incur substantial out-of-pocket costs, with transportation costs constituting nearly half of the total expenditures. National investments in RHD control must be strategically directed at improving health care access and drug supply in order to lower the total costs of secondary prophylaxis and improve adherence rates.
在中低收入国家，费用可能是药物依从性的主要障碍，也是政策干预的重要目标。使用苄星青霉素 G（BPG）进行风湿性心脏病（RHD）二级预防可避免大量发病率和死亡率，但接受这种干预的患者的总自付费用尚不清楚。
估计印度 RHD 患者获得 BPG 预防的总自付费用。
我们前瞻性地收集了新德里一家三级护理中心就诊的 RHD 患者接受二级预防的自我报告药物、交通和提供者相关费用。通过调整药物给药频率的单位成本来估计每月费用。
对 420 名患者（平均年龄（±标准差）为 11.6（±2.9）岁）提供的成本数据进行了分析。大多数患者为男性（65.2%），来自农村地区（87.1%），属于较低社会经济阶层（73.3%）。获得 BPG 注射的每月总自付费用（IQR）中位数为印度卢比（INR）62.5（42.5-117.0）。购买药物的中位数费用（IQR）为 INR 34.0（30.0-39.0）。而卫生保健提供者和交通的中位数费用（IQR）分别为 INR 16.0 [0-32.0]和 INR 11 [0-31.0]。当以平均值（SD）表示时，交通费用占总费用的 50%，而药物采购和药物管理的平均费用分别占总费用的 30%和 22%。
接受 BPG 预防的 RHD 患者承担了大量的自付费用，交通费用几乎占总支出的一半。国家在 RHD 控制方面的投资必须有策略地针对改善医疗保健获取和药物供应，以降低二级预防的总成本并提高依从率。
