Cost-Benefit Analysis and Assessment of Quality of Care in patients with Hemophilia undergoing treatment at National Rural Health Mission in Maharashtra, India.

BACKGROUND

Hemophilia is a genetic disorder with high health care burden. In India, most patients with hemophilia seek care through self-purchasing factor concentrate and incur huge out-of-pocket (OOP) expenditure. In March 2013, the government of India launched a pilot hematology program through the National Rural Health Mission for providing free treatment services to patients with hemophilia in the state of Maharashtra.

OBJECTIVES

To estimate the benefit-cost ratio of the program from a patient perspective, to estimate reduction in OOP expenditure of the patients and their families, and to assess the quality of care delivered and the barriers to access care among patients with hemophilia.

METHODS

This cross-sectional study evaluated the intervention of free treatment to patients with hemophilia at four district civil hospitals of Maharashtra. The study sample included 232 people with hemophilia (193 with hemophilia A, 31 with hemophilia B, 6 with von Willebrand disease, and 2 others) under four study arms over a 1-year study period. Cost-benefit analysis was performed for patients undergoing treatment at government hospitals and through nongovernmental organizations.

RESULTS

The benefit-cost ratio for the government program was 1.89. There was reduction in OOP expenditure by 21% per patient annually for the families. About 98% patients were highly satisfied with the services, whereas a major barrier to access was difficulty in commuting during active bleeding episodes.

CONCLUSIONS

The government intervention through the National Rural Health Mission was cost-beneficial to the patients with hemophilia. It helped in reducing the OOP expenditure by 21%.