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

Abstract

Background: The cardiovascular diseases (CVDs) remains important cause of morbidity and
mortality in Pakistan and impose a substantial financial burden on patients and their families.
Among developing countries, a significant proportion of healthcare costs are paid directly by
patients as out-of-pocket (OOP) expenses, which can adversely affect treatment adherence and
health consequences.
Objectives: To evaluate the out-of-pocket (OOP) healthcare expenditures and associated factors
among patients with CVDs presenting at PUMHS Nawabshah.
Methods: This cross-sectional study was conducted on 200 diagnosed CVD patients attending
inpatient and outpatient cardiology services at PUMHS SBA. All the adult patients, both genders
presented with any cardiovascular disease at 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 stay in Hospital. Descriptive statistics were used to calculate
mean and median OOP costs, using appropriate statistical tests by SPSS version 23, taking p-
value of <0.05 as statistically significant.
Results: Overall mean age of participants was 57.4 ± 10.2 years, and males were in majority
(62%). The average monthly out-of-pocket expenditure for CVD care was approximately PKR
14,500 ± 6,800. Medication costs constituted the largest share of expenses (45–50%), followed
by diagnostic investigations (25–30%) and transportation (10–15%). The higher OOP expenses
were significantly associated with low household income, presence of comorbidities like diabetes
or hypertension and prolonged disease duration, the p-values were quite significant. Around 40%
of patients reported financial hardship or borrowing money to meet healthcare expenses.
Conclusion: Individuals having CVDs were facing to considerable out-of-pocket financial
burden, primarily driven by medication and diagnostic costs, which were adversely influencing
the treatment adherence and health outcomes.
Key words: CVDs, OOP cost, Healthcare expenditures, Comorbidity,