Out-of-Pocket Expenditures of Myocardial Infarction Patients in Pondicherry, South India

Background: Myocardial infarction (MI) is a leading cause of morbidity and mortality worldwide. In India, incidence of MI is rapidly increasing due to lifestyle changes, ageing and rising healthcare costs. The out-of-pocket expenditure (OOPE) for MI care in India can be substantial, as majority of healthcare costs are paid by patients or their families. However, little is known about the actual OOPE incurred by MI patients in tertiary care centres in Pondicherry, South India. This study aims at estimating the OPPE by MI patients attending the tertiary care centre in Pondicherry. The findings can inform policymakers and healthcare providers in developing interventions to reduce the financial burden of MI care in patients and their families. Methods: This was a hospital-based, cross–sectional study conducted on patients attending Cardiology's outpatient department OPD, who had myocardial infarction in the past for about ۳ months to ۳ years at the time of enrolment in the study. A pre-designed and validated questionnaire was used to collect information regarding socio-demographic details and cost of health expenditures (direct medical and non-medical costs and indirect cost for both the participants and caregivers). Data analysis was done using SPSS۲۴ Software. The median and inter-quartile range was used for assessing the cost of health expenditures. Results: Study participants underwent invasive and non-invasive procedure as part of their management. More than ۹۳% underwent invasive, and the cost ranges from ۱,۶۹۴.۰۳ USD to ۲۴۷۰.۰۰ USD (۱,۲۰,۰۰۰ INR to ۱,۷۵,۰۰۰ INR). They spent ۱۰.۵۸ USD to ۲۱.۱۷ USD (۷۵۰ INR to ۱,۵۰۰ INR) for their monthly medication. The travel expenses for each follow-up visit were between ۵.۶۴ USD to ۷۰.۵۷ USD (۴۰۰ INR and ۵۰۰۰ INR). The majority of participants received health insurance or reimbursement of ۱۸۳۴ USD (۱,۳۰,۰۰۰ INR) from their firm, ۱۲.۷% of the participants  lost a payment of ۱۶۲ USD to ۷۷۶.۲۸ USD (۱۱,۵۰۰ INR – ۵۵,۰۰۰ INR). Conclusion: The cost of the invasive procedure for myocardial infarction patients was ۱۶۹۴.۰۳ USD to ۲۴۷۰.۰۰ USD, which was the major share from the out-of-pocket expenditure compared with the other direct and indirect costs.

Keywords:

Direct cost , Indirect cost , Out-Of-Pocket expenditure , Myocardial infarction