Economic Burden in Direct Cost of Chronic Obstructive Pulmonary Disease at a Tertiary Care Teaching Hospital: A Prospective Observational Cohort Study

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is a disease of significantly increasing in terms of economic burden due to its increasing prevalence and high costs. In India because of growing pressure on the health care budget, appropriate reasoning of current expenditure and future investments in public health care becoming a priority. Objective: To evaluate Burden of cost in patients of Chronic Obstructive Pulmonary disease. Material Method: A prospective, observational, non-interventional, cohort study was carried out over a period of six months for Chronic Obstructive Pulmonary Disease (COPD) inpatients at medical wards of Sheth V. S. hospital, Ahmedabad, Gujarat, India. Burden of cost had been evaluated as a part of Pharmacoeconomic. Direct medical and non-medical cost were included in the burden of cost. From the drug rate manual of hospital, cost for drugs and investigation were calculated. Result: Total numbers of 70 patients in which 53 were male and 17 were female with mean age of 60.21 ± 10.29. Minimum total direct medical cost was Rs. 864.00 and maximum was Rs. 5876.00 with a mean ± SD 2418.12 ± 839.73, in which medicine cost was high. Minimum total direct non-medical cost was Rs. 149.00 and maximum was Rs. 1069.00 with a mean ± SD 528.10 ± 212.72, in which additional charges was high. Minimum total direct cost was Rs. 1103.00 and maximum was Rs. 6945.00 with a mean ± SD 2946.22 ± 1009.23. Direct medical cost contribute 82% and direct non-medical costs contribute 18% of total direct cost. Conclusion: COPD has a substantial impact on health-care costs particularly for hospitalization. Pharmacoeconomic evaluation of COPD is essential to obtain optimal therapy at lowest price and alternative treatment plans to gain appropriate health care services Costs of COPD were exceptionally low in India compared to data obtained from developed countries.

Impact of a Clinical Pharmacist Intervention on Medicine Costs in Patients with Chronic Obstructive Pulmonary Disease in India

“…These savings are still high at US$17.49 (a reduction of 26.1%) when factoring in clinical pharmacy time (Table 3), with a percentage reduction at 30.6% for those with very severe disease if we had evaluated medicine costs over 12 months rather than 6 months. The findings that the costs of medicines increase with disease severity is expected, similar to those of Hilleman and others [27,31,68]. These savings in medicine costs are important given the extent of co-payments for medicines for patients with COPD in both India and other LMICs [8,33,52,53].…”

“…If anything, care appears to be improved with this pharmacist-led intervention, with findings from other parts of this research project showing improved adherence to medicines, as well as improved HRQOL in patients with COPD following the intervention [44,46]. This is encouraging given the extent of COPD in India, and its current impact on morbidity, mortality and costs [5,6,8,10,15,31].…”

“…As mentioned, no attempt was made to look at the impact of any changes in medicine use on longer-term costs, including future hospitalisations due to exacerbations, as the main emphasis was on the cost of medicines (the principal cost component) [31], much of which will be out-of-pocket [8,33].…”

“…The current economic burden of COPD in India is largely unknown [8], although Patel et al calculated direct medical costs were up to Indian Rupees (INR) 5876.00 (US$88.23) per patient from admission to discharge among hospitalised patients, with the cost of medicines constituting a substantial proportion, at over five times the hospital charges [31]. This is very different to the situation in higher-income countries.…”

“…We concentrated on these two direct medical costs initially since the costs of medicines currently account for approximately 38% of total healthcare costs in India vs. approximately 10% of total healthcare costs among developed countries, much of which is out-of-pocket [33,53,61,62]. In addition, as mentioned, costs of medicines for patients with COPD is currently appreciably higher than hospital charges [31].…”