Abstract
BackgroundGlobally, an estimated 54 million people have angina, 16 million of whom are from the WHO South-East Asia region. Despite the increasing burden of cardiovascular disease (CVD) in South Asia, there is no evidence of an economic burden of angina on households in this region. We investigated the economic burden of angina on households in South Asia.MethodsWe applied a novel propensity score matching approach to assess the economic burden of angina on household out-of-pocket (OOP) health spending, borrowing or selling assets, non-medical consumption expenditure, and employment status of angina-affected individual using nationally representative World Health Survey data from Bangladesh, India, Nepal and Sri Lanka collected during 2002-2003. We used multiple matching methods to match households where the respondent reported symptomatic or diagnosed angina with control households with similar propensity scores.ResultsAngina-affected households had significantly higher OOP health spending per person in the four weeks preceding the survey than matched controls, in Bangladesh (I$1.94, p = 0.04), in Nepal (I$4.68, p = 0.03) and in Sri Lanka (I$1.99, p < 0.01). Nearly half of this difference was accounted for by drug expenditures. Catastrophic spending, defined as the ratio of OOP health spending to total household expenditure in excess of 20%, was significantly higher in angina-affected households relative to matched controls in India (9.60%, p < 0.01), Nepal (4.90%, p = 0.02) and Sri Lanka (9.10%, p < 0.01). Angina-affected households significantly relied on borrowing or selling assets to finance OOP health expenses in Bangladesh (6%, p = 0.03), India (8.20%, p < 0.01) and Sri Lanka (7.80%, p = 0.01). However, impoverishment, non-medical consumption expenditure and employment status of the angina-affected individual remained mostly unaffected. We adjusted our estimates for comorbidities, but limitations on comorbidity data in the WHS mean that our results may be upwardly biased.ConclusionsHouseholds that had the respondent reporting angina in South Asia face an economic burden of OOP health expenses (primarily on drugs and other outpatient expenses), and tend to rely on borrowing or selling assets. Our analysis underscores the need to protect South Asian households from the financial burden of CVD.
Highlights
An estimated 54 million people have angina, 16 million of whom are from the World Health Organization (WHO) South-East Asia region
Using propensity score matching (PSM), we examined whether OOP health spending, expenditure on drugs and hospitalization, employment and non-medical consumption spending in angina-affected households were different from those of control households
Per person OOP health spending was generally higher in households that had the respondent reporting symptomatic or diagnosed angina relative to matched controls across all four South Asian countries we studied, and this difference was statistically significant in Bangladesh (I$8.80 versus in last four weeks (I$)6.86, p = 0.04), Nepal (I$9.65 versus I$4.97, p = 0.03) and Sri Lanka (I$4.22 versus I$2.23, p < 0.01)
Summary
An estimated 54 million people have angina, 16 million of whom are from the WHO South-East Asia region. The World Health Organization (WHO) estimates that 54 million people live with angina pectoris globally, of whom 16 million are from the WHO South-East Asia region. One study for India showed that out-of-pocket (OOP) payments for hospital care associated with cardiovascular disease (CVD) amounted to almost 30% of annual expenditures among households to which patients belonged [7]. Another study for LMICs showed that OOP expenses for hospital care for CVD exceeded the catastrophic threshold (defined as 40% of non-food expenditure) in 50% of the hospitalized cases in India, China, and Tanzania [8]. These analyses focus on hospitalized cases, usually arising from heart attacks. In South Asia, where the burden of CVD is likely to rise sharply in future years, an assessment of the economic burden of angina can help in the design of effective policies
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