AB1142 TREATMENT COSTS OF SELECTED RHEUMATIC DISEASES IN SUB-SAHARAN AFRICA: A CASE FOR IMPROVED INSURANCE COVERAGE FOR AFRICAN PATIENTS

Abstract

Background:Rheumatic diseases lead to substantial economic costs1especially in resource-poor settings like sub-Saharan Africa (SSA).2Annual direct cost of lupus treatment ranges from $13,735-20,926 /patient in the US to £3231($4232)/patient in the UK.1,3Data is rare for SSA and Nigeria in particular where the minimum wage is N30,000 ($83/mth) with only 5% of citizens covered by health insurance.4,5The scheme excludes some medications and certain procedures are grossly underfunded. Cost-of-illness studies are invaluable in planning and policy development. They typically include: direct, indirect and intangible costs.6Objectives:To compare total costs of some rheumatic diseases, highlight underfunded therapies and push for wider insurance coverage of rheumatic diseases.Methods:A cross-sectional study from the University of Uyo Teaching Hospital - Nigeria using data of 252 clinic patients (20 lupus, 27 rheumatoid arthritis, 25 gout and 180 osteoarthritis). Direct costs were estimated using the hospital pricelist while indirect costs were estimated using the human capital method. Statistical analysis was done with p<0.05.Results:Females were the majority except for gout patients (44%). Most lupus patients were unemployed (75%) and had the highest annual total cost (N472,800–2,240,400) compared with the others. Key medications excluded from insurance are shown in table 2.Table 2.Uninsured treatments.MMFMethotrexateSulphasalazineAzathioprineHCQFebuxostatColchicineRituximabArthroplasty (N100,000*)Dialysis (6 sessions)Renal transplantTABLE 1.COST-OF-ILLNESS COMPARISON OF SELECTED RHEUMATIC DISEASESLupus (n=20)RA(n=27)Gout(n=25)OA(n=180)Age (years)33.9 ± 11.443.4 ± 14.357.4 ± 9.659.7 ± 9.1Female n (%)24(95)25(92)11(44)157(87)Average Duration of illness (years)4(1-11)3.5(2-10)3 (0.2-8)4(0.1-20)Unemployed n (%)15(75.0)19(70.3)12(48.0)62(34.4)Workdays missed/mth7523Direct costs (N’000)Total /mth (stable)32.42719.7518Total /yr (stable)388.8324237216Total /mth (severe)179.7155.632.523Total /yr (severe)2,156.41,867.2390276Indirect costsProductivity loss/mth7523Productivity loss/yr84602436Total costs/mthTotal costs/yr39.4 – 186.7472.8 – 2,240.432 – 160.6384 – 1.927.221.75 – 34.5261 – 41421 – 26252 – 3121$ = 360 Nigerian Naira (NGN), 1€ = NGN 402 as at 31/1/2020. Costs quoted in thousands of Naira.Conclusion:Total annual cost of lupus treatment in Nigeria is quite high ranging from (NGN 472,800–2,242,400) [$1313- 6228] for mild to severe disease. This contrasts with a mean annual national income of $1,000 given that 75% of lupus patients are unemployed. Expanded insurance coverage for rheumatic drugs will further reduce the enormous treatment burden and improve outcomes.