Abstract
BackgroundSri Lanka has a high prevalence of β-thalassaemia major. Clinical management is complex and long-term and includes regular blood transfusion and iron chelation therapy. The economic burden of β-thalassaemia for the Sri Lankan healthcare system and households is currently unknown.MethodsA prevalence-based, cost-of-illness study was conducted on the Thalassaemia Unit, Department of Paediatrics, Kandy Teaching Hospital, Sri Lanka. Data were collected from clinical records, consultations with the head of the blood bank and a consultant paediatrician directly involved with the care of patients, alongside structured interviews with families to gather data on the personal costs incurred such as those for travel.ResultsThirty-four children aged 2–17 years with transfusion dependent thalassaemia major and their parent/guardian were included in the study. The total average cost per patient year to the hospital was $US 2601 of which $US 2092 were direct costs and $US 509 were overhead costs. Mean household expenditure was $US 206 per year with food and transport per transfusion ($US 7.57 and $US 4.26 respectively) being the highest cost items. Nine (26.5%) families experienced catastrophic levels of healthcare expenditure (> 10% of income) in the care of their affected child. The poorest households were the most likely to experience such levels of expenditure.Conclusionsβ-thalassaemia major poses a significant economic burden on health services and the families of affected children in Sri Lanka. Greater support is needed for the high proportion of families that suffer catastrophic out-of-pocket costs.
Highlights
MethodsData were collected from clinical records, consultations with the head of the blood bank and a consultant paediatrician directly involved with the care of patients, alongside structured interviews with families to gather data on the personal costs incurred such as those for travel
Sri Lanka has a high prevalence of β-thalassaemia major
As well as patients living in the hospital catchment area, many patients from adjoining districts attend for specialised medical care such as thalassaemia management
Summary
Study location This study was undertaken in Kandy Teaching Hospital (KTH) in the Central province of Sri Lanka. Staff costs were allocated to individual patients based on the complexity of their care needs categorised according to a four point scale, with each category representing a measure of workload intensity (Table 1). Hospital costs were inflated to take into account the indirect costs of care using the mark-up method [24] With this method, the ratio of indirect to direct costs is calculated based on available budget information, used to adjust the direct costs associated with the patient population of interest (and for which indirect cost information is not available) providing an estimate of the total hospital cost (direct + indirect). The price of equipment along with its estimated life expectancy was used to calculate the equipment cost per test. A Pearson correlation test was used for analysis and Pvalue < 0.05 for statistical significance
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