Effect of healthcare expenditure on the health related quality of life among diabetic patients of South India: A cross- sectional study

Abstract

BackgroundDiabetes mellitus imposes a huge economic burden along with impairing health related quality of life (HRQoL) among patients. The purpose of this study was to determine the effect of healthcare expenditure on HRQoL among diabetic patients. MethodsA Cross -Sectional study was carried out among 328 Type 2 diabetics in Southern India. HRQoL was assessed using EQ-5D-5L questionnaire and data regarding expenditure were gathered using a validated questionnaire. Poisson regression and Multivariate regression analysis were performed to predict the factors associated with healthcare expenditure and quality of life respectively. ResultsThe annual expenditure in management of diabetes was INR 10969.6 (USD 132.83) with direct medical cost INR 8727 (USD 105.67) forming the bulk. 11.6% of participants spent over 30% of their annual income in diabetes care. Older age group, being obese, lower socioeconomic status, longer duration of diabetes, presence of complication, episodes of hospitalization were associated with higher healthcare expenditure. Mean quality of life score was 0.84 ± 0.13 and mean visual analog score was 73.15 ± 11.21. Participants with EQ-5D-5L index of range (0.0–0.3) had an expenditure of INR 31703.56. On linear regression analysis, proportion of total income spent for diabetes care was associated with poor quality of life (β = −0.163, 95% CI = −0.239 to −0.086, p < 0.001). ConclusionCost of diabetes care was inordinately high and an increased spending particularly among the socioeconomically disadvantaged group, resulting in poorer QoL. Policymakers need to focus on strengthening primary healthcare facilities for Non-Communicable diseases and implementing cost containment policy for reducing the financial burden.