Introduction:
Out-of-pocket costs are a major barrier to medication adherence in low and middle income countries and an important target for policy-level interventions. The total economic burden for patients receiving secondary penicillin prophylaxis for Rheumatic Heart Disease (RHD) is uncertain.
Methods:
We prospectively collected self-reported out-of-pocket drug, transportation, and provider costs from patients in the AIIMS Pediatric RHD Registry. Monthly costs were estimated by adjusting visit costs for frequency of drug administration. Because adverse drug reactions are rare, we did not collect complication-related costs. Mean (±SD) costs are reported in 2013 Indian Rupee (INR) and International Dollars (INT$).
Results:
In our registry, 230 patients provided cost data over 313 visits. The mean age was 11.8 (±2.9) years, and 83 (36%) were girls. The majority of patients resided in rural areas (n=197, 86%), and were from the lower and upper lower socioeconomic strata (n=160, 70%) on the modified Kuppuswami scale. Nearly all patients hailed from outside Delhi (91%), reflecting the referral population of our tertiary hospital.
The monthly out-of-pocket cost was INR 74.92 (±109.00) or INT$ 4.04 (±5.88), drug cost forming 36% of the total costs (INR 26.71 [±11.6]; INT$ 1.44 [± 0.63]). Provider costs (INR 18.21 [±32.48]) and transportation costs (INR 30.00 [±106.51]) comprised 24% and 40% of total costs respectively. Provider and transportation costs exceeded the drug costs for 38% of the patients. Patients traveled 12 (±38) km round trip to obtain penicillin prophylaxis.
Conclusions:
Drug costs constitute only 36% of the total out-of-pocket cost of penicillin prophylaxis for RHD, with provider costs (24%) and transportation costs (40%) comprising the remainder. Because out-of-pocket costs can be a major barrier to long-term adherence, future efforts must be directed at improving access to and lowering total costs of penicillin prophylaxis for RHD.
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