Abstract
Background: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The adverse impact of HF on the economic well-being has been narrated in various anecdotal reports from India, with affected individuals and their dependents pushed into the vicious cycle of poverty. There is limited research quantifying how HF impacts the economic well-being of households from low- and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The study will be initiated across 20 hospitals in India, which are part of the National heart Failure Registry (NHFR). The selected centres represent different regions in India, stratified based on the prevailing stages of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect data by using a validated and structured interview schedule. The study will have 80% power to detect an 8% difference in the proportion of households experiencing catastrophic health expenditures between two ETL groups. After considering a non-response rate of 5%, the target sample size is approximately 600 patients from each group and the total sample size is 1800 patients. Potential Impact: Our study will provide information on catastrophic health spending, distress financing and household expenditure in heart failure patients. Our findings will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.
Highlights
We have changed several sentences in the introduction based on the comments from the reviewers.Sample size calculation We made a minor modification in the sample size statement.Any further responses from the reviewers can be found at the end of the article Introduction Globally, non-communicable diseases (NCDs) are one of the major causes of death and disability
We describe the methods of a detailed economic impact assessment of Heart failure (HF) at the household level in India
The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure
Summary
Any further responses from the reviewers can be found at the end of the article Introduction Globally, non-communicable diseases (NCDs) are one of the major causes of death and disability. Among NCDs, cardiovascular disease (CVD) is responsible for a major share of premature deaths and disability. The burden of CVD is expected to grow in the coming years especially in the low- and middle-income countries (LMICs). Since LMICs have the dual burden of disease – both from communicable and non-communicable diseases – NCDs exert a tremendous strain on the already challenged health systems. The adverse impact of HF on the economic well-being has been narrated in various anecdotal reports from India, with affected individuals and their dependents pushed into the vicious cycle of poverty. There is limited research quantifying how HF impacts the economic well-being of households from low- and middle-income countries.
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