Bagepally Bhavani Shankara, Kumar S Sajith, Sasidharan Akhil
Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, India.
Clinicoecon Outcomes Res. 2024 Mar 26;16:187-196. doi: 10.2147/CEOR.S452679. eCollection 2024.
Efficient allocation of healthcare resources requires a comprehensive evaluation of healthcare spending and its impact on disease burden. This study aims to estimate the costs-per disability-adjusted life years (DALY) in India. Data from 2010 to 2019 on DALYs and health expenditure per capita (HEp) for individual states in India were utilised.
We followed the CHEERS statement 2022 to present our study's methodology and outcomes. Pearson's product-moment correlations were used to analyse associations between DALYs and HEp. A panel regression analysis was conducted using a log regression model to estimate changes in DALYs due to health expenditure changes. All costs are reported in Indian rupee (₹) along with its 95% CI, with a conversion factor of 1 US$ = ₹82.4 applied.
The costs-per-DALY were estimated for each state and India. DALY was negatively correlated with HEp. The estimated mean cost-per-DALY for India was ₹82,112 (₹55,810 to ₹1,08,413) [$997 ($667 to $1316)]. The mean cost per-DALY varied across states, with value of ₹27,058 (₹22,250 to ₹31,866) [$328 ($270 to $387)] for states in the first quartile based on Human Development Index (HDI) and ₹2,69,175 (₹1,05,946 to ₹4,32,404) [$3267 ($1286 to $5248)] for those in fourth HDI quartile. States such as Gujarat (0.16), Karnataka (0.17) and Maharashtra (0.22) have lower, and Arunachal Pradesh has the highest cost-per-DALY to Gross state domestic product per-capita ratio (2.41), followed by Nagaland (1.45).
Higher healthcare investment has a lower disease burden; however, reduction in DALY varies across states. Study findings provide evidence to aid the setting up of differential willingness-to-pay thresholds across Indian states for efficient and equitable healthcare resource allocation.
高效分配医疗资源需要全面评估医疗支出及其对疾病负担的影响。本研究旨在估算印度每伤残调整生命年（DALY）的成本。利用了印度各邦2010年至2019年关于DALYs和人均卫生支出（HEp）的数据。
我们遵循2022年CHEERS声明来展示本研究的方法和结果。使用皮尔逊积矩相关性分析DALYs与HEp之间的关联。使用对数回归模型进行面板回归分析，以估算由于卫生支出变化导致的DALYs变化。所有成本均以印度卢比（₹）报告，并带有其95%置信区间，应用的换算因子为1美元 = ₹82.4。
估算了印度各邦以及印度整体每DALY的成本。DALY与HEp呈负相关。印度估算的每DALY平均成本为₹82,112（₹55,810至₹1,08,413）[997美元（667美元至1316美元）]。各邦每DALY的平均成本有所不同，基于人类发展指数（HDI）处于第一四分位数的邦，其值为₹27,058（₹22,250至₹31,866）[328美元（270美元至387美元）]，而处于HDI第四四分位数的邦为₹2,69,175（₹1,05,946至₹4,32,404）[3267美元（1286美元至5248美元）]。古吉拉特邦（0.16）、卡纳塔克邦（0.17）和马哈拉施特拉邦（0.22）等邦的每DALY成本较低，而阿鲁纳恰尔邦的每DALY成本与人均邦国内生产总值之比最高（2.41），其次是那加兰邦（1.45）。
更高的医疗投资带来更低的疾病负担；然而，DALY的降低在各邦之间存在差异。研究结果为在印度各邦设定不同的支付意愿阈值以实现高效且公平的医疗资源分配提供了证据。
