Cost Out-of-Pocket Expenses with Cardiovascular Diseases at PMCH Nawabshah – COUP Study

Abstract

Objectives: To evaluate out-of-pocket (OOP) healthcare expenditures and associated factors among patients with cardiovascular diseases (CVDs) presenting at PUMHS Nawabshah.

Methodology: This cross-sectional study was conducted among 200 diagnosed CVD patients attending inpatient and outpatient cardiology services at PUMHS SBA from October 2023 to March 2024. All adult patients of both genders presenting with any cardiovascular disease at the cardiology department were enrolled. Patients were assessed for sociodemographic characteristics, type of cardiovascular disease, duration of illness, and direct medical and non-medical expenses, including consultation fees, medications, diagnostic tests, transportation, and hospital stay. Descriptive statistics were used to calculate the mean and median OOP costs. Appropriate statistical tests were applied using SPSS version 23, with a p-value of <0.05 considered statistically significant.

Results: The overall mean age of participants was 59.3 ± 14.36 years, and the majority were males (67.6%). The mean annual medication cost was 117,735.31 PKR. Patients were hospitalized an average of 2.02 times per year, with a mean total of 9.63 inpatient days annually, incurring a mean annual hospitalization cost of 68,191.50 PKR. Yearly transportation-related expenses averaged 35,946.04 PKR. Collectively, the overall mean annual out-of-pocket expenditure per patient was 259,908.06 PKR. Out-of-pocket spending exceeding 10% of household income was observed in all patients, indicating that every participant in the study faced financially catastrophic healthcare costs. Additionally, a significant majority of patients (97.2%) reported borrowing money to meet their treatment expenses, and 73.8% were compelled to sell household assets to finance their care.

Conclusion: Individuals with CVDs faced a considerable out-of-pocket financial burden, primarily driven by medication and diagnostic costs, which adversely influenced treatment adherence and health outcomes.