Direct and indirect costs of COPD treatment in Pune city, India

COPD is the 2nd leading cause of deaths and DALYs in India and likely contributes to a huge economic burden. Most health care expenditure in India is out-of-pocket and little is contributed by the government and medical insurance. In this study, we aimed to examine out-of-pocket expenditure for patients of COPD visiting government, semi-private and private hospitals/clinics. Methods: 239 doctor diagnosed and spirometry confirmed (168 Males, Mean age 66.9 ± 8.9 years) mild-to-very severe COPD patients (8 mild, 76 moderate, 130 severe-very severe) on medications for at least one year were recruited from different hospital settings. One year expenditure was calculated retrospectively which included direct costs (physician consultation, Investigations, drugs and hospitalization costs) and indirect costs (travel, work days lost and professional caretaker cost) were captured using a detailed questionnaire. Results: The annual mean out-of-pocket expenditure for patients visiting government hospital was Indian Rupees (INR) 11835.85 ± 10799.64, Semi-private hospitals was INR 44003.02 ± 54146.75, private hospitals & clinics was INR 50805.24 ± 172916.43 (Fig). 49.3% of the out-of-pocket expenditure was accounted for by hospitalization cost. Conclusion: Out-of-pocket expenditure for COPD in India is very high and is largely driven by hospitalisaiton costs and drug costs.