The financial repercussions of rheumatoid arthritis and determinants of catastrophic healthcare expenditure: insights from the Karnataka chapter of the Indian rheumatology association.

OBJECTIVES

To estimate the financial burden and the determinants of catastrophic healthcare expenditure(CHE) in patients with rheumatoid arthritis(RA) residing in the state of Karnataka, India.

METHODS

This was a cross-sectional, questionnaire-based study carried out by the practicing rheumatologists across 17 centers in Karnataka, India. Patients with RA diagnosed as per ACR classification criteria and on follow-up for at least 1-year were interviewed regarding disease-related expenditures which included direct medical and non-medical costs. CHE defined as > 20% of annual family income was analysed for various sociodemographic and clinical variables. Results are presented in Indian currency (INR), wherein 100 INR = 1.17 USD = 1.06 EURO.

RESULTS

We included 2141 patients with RA (M: F::11:89), mean age 50.9 ± 12 years. The median annual expenditure towards treatment of RA including all direct medical and non-medical costs was ₹32200(IQR 21600,45200), the largest proportion (41.0%) being for RA medications. More than 10% annual income was being spent for treatment of RA by 48.1%(n = 1029)] of patients while CHE (> 20%) was noted in 582(27.1%) patients. Longer time taken for referral to rheumatologist [β = 1.28 (1.15,1.43)], longer duration of illness [β = 1.002(1.001,1.003)], presence of comorbidity [β = 1.12(1.04,1.22)] and disability HAQ-DI > 2 [β = 1.37(1.20,1.56)] had significant association with higher direct expenditure. Patients belonging to lower SES [AOR 2.66(1.99,3.56)], primary and middle level of patient education [AOR 1.57(1.05,2.36) & 2.01(1.32,3.07)] and hospitalisation [β = 9.20(6.25,13.6)] incurred CHE.

CONCLUSION

The primary drivers of high direct expenditure in patients with RA in Karnataka, India are cost of medications, delayed specialist referral, high disease activity, disability and comorbidities. Additionally, hospitalization significantly contributes to CHE.