Economic burden associated with stroke in India: insights from national sample survey 2017-18

ABSTRACT

Objective

To estimate the out-of-pocket (OOP) expenditure and catastrophic expenditure due to stroke-related hospitalization and determine associated predictors.

Methods

Secondary analysis of household-based survey conducted by National Sample Survey Organization from June 2017 to 2018.

Results

A total of 1152 and 407 individuals reported stroke-related hospitalization and outpatient care, respectively, in the survey. Stroke-related hospitalization rate in India is 46 per 100,000 persons. The mean and median expenditure per episode of stroke-related hospitalization was INR 40,360 (US$ 539.75) and INR 17,140 (US$ 229.22), respectively, with significant OOP hospitalization expenditure across wealth quintiles (p < 0.001). About 29% (25–34%) of households seeking stroke treatment in public medical institutions experienced catastrophic expenditure. 37% (34–40%) of households resorted to distress health financing due to stroke-related hospitalization. Medicines accounted on an average 38% and 73% of public sector hospitalization and outpatient care, respectively. Patients treated in a private facility, hospitalized for over 7 days, within the poorest wealth quintiles had higher odds of incurring catastrophic expenditure.

Conclusion

Economic burden associated with stroke-related hospitalization is substantial in India. The publicly funded health insurance scheme should cover expenses on stroke-related medicines to reduce OOP expenditure of patients seeking treatment in public sector facilities.

KEYWORDS:

• Household survey
• stroke
• hospitalization rate
• cost-of-illness
• catastrophic expenditure
• impoverishment

Acknowledgments

We would like to acknowledge the kind support extended in data handling by Mr Rajesh Dahima, Centre for Technology and Policy at Indian Institute of Technology Madras and Mr Saravanan E, Health Technology Assessment Resource Centre, Jawaharlal Institute of Postgraduate Medical Education and Research for his comments and suggestions on the data analysis.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Author contribution

Both authors contributed to the conception of the article. Subramania Raju Rajasulochana performed the analysis and prepared the manuscript. Dr Sitanshu Sekhar Kar advised on revision of the manuscript. Both authors read and approved the final manuscript.