Household Economic Burden Research Articles

422. Household Economic Burden and Social Consequences of Childhood Severe Pneumonia in India: A Cost of Illness based Pharmacoeconomic Analysis

Abstract Background Childhood pneumonia stands as a leading cause of mortality among young populations. Providing care for pediatric pneumonia poses significant challenges in resource-constrained regions, where caregivers often bear treatment expenses directly. This study aimed to evaluate the burden, social impact, and economic ramifications of childhood pneumonia, as well as to identify associated risk factors. Methods An incidence-based Cost of Illness (COI) study was conducted, focusing on one episode of severe childhood pneumonia from a household perspective. The study was carried out across three distinct sites in the South Indian state of Kerala, India. Through face-to-face interviews, data on socioeconomic status, resource utilization, and associated costs were gathered from caregivers of children aged between 1 month and 6 years. Utilizing a micro-costing bottom-up methodology, medical, non-medical, and time-related costs were computed. Multiple regression analysis was employed to examine factors influencing COI, while sensitivity analysis was conducted to assess the robustness of cost estimations. Results A total of 436 children with severe pneumonia were enrolled between January 2022 and December 2023. The mean age of participants was 14 months (SD ±9.1), with males constituting 58.7% (256). The average household cost per episode amounted to USD 149 (95% CI; 139.7 - 155.9), with indirect costs serving as the primary cost drivers (65%, USD 98). While household expenses for the poorest income quintile were lower in absolute terms, they represented a higher proportion of monthly income. Notably, COI was significantly higher for treatments sought at urban health facilities compared to rural counterparts (difference USD 54.3, 95% CI 73.3 to 96.3). Additionally, factors such as age, parental education level, and healthcare facility location emerged as significant predictors of household COI. Conclusion This study underscores the substantial economic burden imposed on households by severe childhood pneumonia, with cost differentials evident across various socioeconomic strata. In light of these findings, tailored management strategies should be devised for resource-limited settings to enhance treatment affordability and alleviate household economic strain. Disclosures All Authors: No reported disclosures

The economic burden of visceral leishmaniasis and barriers to accessing healthcare in Tigray, North Ethiopia: A field based study.

Visceral leishmaniasis (VL) is an important public health problem, which mainly affects the poor rural dwelling communities in Low- and Middle-Income Countries. However, little is known about the health and economic burdens of this disease in East Africa, including Ethiopia. The aim of this study was to assess the household level economic burden of VL among affected communities in Tigray, Northern Ethiopia. Between April and August 2020, a cross-sectional household survey was conducted on 96 patients who had been treated for VL within 12 months prior to the survey, in six districts of Tigray. Data on households' health seeking behavior, direct and indirect costs and coping strategies were collected using a structured questionnaire and the responses were analyzed using SPSS software. Most (82%) of the patients surveyed were males and the majority (74%) of them were between 16 and 30 years of age. The education level of participants was very low: over 33% had not received any form of education; 48% of patients were farmers dependent on subsistence agriculture and about 32% were daily laborers. Just under half of household families (46%) resided in "poor houses" with structures made from entirely local materials. Forty-one percent of patients from the surveyed households had traveled 48 to 72 kilometers to reach VL treatment hospitals. The median total household cost for one VL episode was estimated to be US$ 214. This is equated to 18% of the mean total annual household income or 72.5% of annual per capita income of the study population. More than 80% of the households surveyed incurred catastrophic costs of VL, where this is defined as exceeding 10% of annual household income. The median delay between the onset of symptoms and arrival at a care provider hospital was 37 days; once the patient arrived at hospital, the median delay during diagnosis was 3 days. Direct and indirect costs represented 44% and 56% of the total costs incurred, respectively. To cope with VL treatment costs, 43% of the households used more than one coping strategy: 48% took out loans, 43% sold livestock and 31% of households mobilized cash savings. VL in Tigray is concentrated among young males with low educational background and mostly engaged in subsistence economic activities. Despite the free diagnostic and treatment provisions that were available at public hospitals at the time of the study, our work shows that the household economic burden of the disease had significant impact among VL-affected communities in Tigray. Initiating community awareness towards prevention, early treatment seeking and decentralization of VL treatment centers are strongly recommended. In addition, we recommend efforts to reduce household treatment costs through transport and food provisions for patients (and their accompanying carers where possible) or through cash reimbursement for patients who complete treatment at public hospitals, in order to reduce the barriers to seeking treatment for this life-threatening disease.

Household economic burden of type-2 diabetes and hypertension comorbidity care in urban-poor Ghana: a mixed methods study

BackgroundNon-communicable diseases (NCDs) predispose households to exorbitant healthcare expenditures in health systems where there is no access to effective financial protection for healthcare. This study assessed the economic burden associated with the rising burden of type-2 diabetes (T2D) and hypertension comorbidity management, and its implications for healthcare seeking in urban Accra.MethodsA convergent parallel mixed-methods study design was used. Quantitative sociodemographic and cost data were collected through survey from a random community-based sample of 120 adults aged 25 years and older and living with comorbid T2D and hypertension in Ga Mashie, Accra, Ghana in November and December 2022. The monthly economic cost of T2D and hypertension comorbidity care was estimated using a descriptive cost-of-illness analysis technique from the perspective of patients. Thirteen focus group discussions (FGDs) were conducted among community members with and without comorbid T2D and hypertension. The FGDs were analysed using deductive and inductive thematic approaches. Findings from the survey and qualitative study were integrated in the discussion.ResultsOut of a total of 120 respondents who self-reported comorbid T2D and hypertension, 23 (19.2%) provided complete healthcare cost data. The direct cost of managing T2D and hypertension comorbidity constituted almost 94% of the monthly economic cost of care, and the median direct cost of care was US$19.30 (IQR:10.55–118.88). Almost a quarter of the respondents pay for their healthcare through co-payment and insurance jointly, and 42.9% pay out-of-pocket (OOP). Patients with lower socioeconomic status incurred a higher direct cost burden compared to those in the higher socioeconomic bracket. The implications of the high economic burden resulting from self-funding of healthcare were found from the qualitative study to be: 1) poor access to quality healthcare; (2) poor medication adherence; (3) aggravated direct non-medical and indirect cost; and (4) psychosocial support to help cope with the cost burden.ConclusionThe economic burden associated with healthcare in instances of comorbid T2D and hypertension can significantly impact household budget and cause financial difficulty or impoverishment. Policies targeted at effectively managing NCDs should focus on strengthening a comprehensive and reliable National Health Insurance Scheme coverage for care of chronic conditions.

Associations between child marriage and food insecurity in Zimbabwe: a participatory mixed methods study.

Child marriage is a global crisis underpinned by gender inequality and discrimination against girls. A small evidence base suggests that food insecurity crises can be both a driver and a consequence of child marriage. However, these linkages are still ambiguous. This paper aims to understand how food insecurity influences child marriage practices in Chiredzi, Zimbabwe. Mixed methods, including participant-led storytelling via SenseMaker® and key informant interviews, were employed to examine the relationship between food insecurity and child marriage within a broader context of gender and socio-economic inequality. We explored the extent to which food insecurity elevates adolescent girls' risk of child marriage; and how food insecurity influences child marriage decision-making among caregivers and adolescents. Key patterns that were generated by SenseMaker participants' interpretations of their own stories were visually identified in the meta-data, and then further analyzed. Semi-structured guides were used to facilitate key informant interviews. Interviews were audio-recorded, and transcribed and translated to English, then imported into NVivo for coding and thematic analysis. A total of 1,668 community members participated in SenseMaker data collection, while 22 staff participated in interviews. Overall, we found that food insecurity was a primary concern among community members. Food insecurity was found to be among the contextual factors of deprivation that influenced parents' and adolescent girls' decision making around child marriage. Parents often forced their daughters into marriage to relieve the household economic burden. At the same time, adolescents are initiating their own marriages due to limited alternative survival opportunities and within the restraints imposed by food insecurity, poverty, abuse in the home, and parental migration. COVID-19 and climate hazards exacerbated food insecurity and child marriage, while education may act as a modifier that reduces girls' risk of marriage. Our exploration of the associations between food insecurity and child marriage suggest that child marriage programming in humanitarian settings should be community-led and gender transformative to address the gender inequality that underpins child marriage and address the needs and priorities of adolescent girls. Further, programming must be responsive to the diverse risks and realities that adolescents face to address the intersecting levels of deprivation and elevate the capacities of adolescent girls, their families, and communities to prevent child marriage in food insecure settings.

Public willingness to pay for farmland non‐point source pollution governance toward sustainable development: A choice experiment in Gansu, China

AbstractClarifying public willingness to pay (WTP) for farmland non‐point source pollution (FNSP) governance helps to establish an ecological compensation mechanism with public participation. This will reduce China's agricultural pollution and its environmental and food safety consequences while promoting sustainable development. Nevertheless, research has yet to reveal the public WTP within China's FNSP governance policy framework. To this end, a “2030‐oriented FNSP governance program” choice experiment with specific FNSP governance measures (fertilizer reduction, pesticide reduction, straw resource utilization, and mulch film recycling) was conducted in Gansu Province to reveal the public WTP for FNSP governance and its key influencing factors. Results from mixed logit models show that urban residents' marginal WTP (MWTP) for improving the FNSP status quo and different measures for fertilizer reduction, pesticide reduction, straw resource utilization, and mulch film recycling is ¥151.62, ¥1.33, ¥7.3, ¥4.85, and ¥3.16 annually, respectively, indicating the highest preference for reducing pesticides because of food safety problems. Meanwhile, the average individual WTP for optimal FNSP governance schemes is ¥513.02 annually, accounting for only 3.86‰ of annual household income; the regional aggregate social welfare of optimal FNSP governance is as high as ¥2038.23 million, accounting for 2.81% of GDP in 2020. This means that FNSP governance can bring substantial social welfare with a low household economic burden. In addition, the perception that food safety has improved in the past 5 years or an awareness of food safety incidents can enhance the willingness of urban residents to change the status quo of FNSP: the more serious the respondents perceive food safety problems to be, the stronger the above effects, indicating the critical impact of food safety factors on the public's WTP for FNSP governance. The study's findings highlight the potential to find socially acceptable ways to promote FNSP governance as well as provide insight into the relevant policymaking process from the standpoint of public participation and food safety.

Impact of Influenza and Pneumococcal Polysaccharide Vaccination on Economic Burden from Acute Exacerbations of Chronic Obstructive Pulmonary Disease - Hebei Province, China, November 2018 to November 2020.

Chronic obstructive pulmonary disease (COPD) exacerbations increase household economic burden, but there is limited evidence from prospective cohort studies in China about the impact of vaccination on economic burden. This study demonstrated the economic burden of COPD exacerbations, pneumonia, and hospitalization in COPD patients in China is substantial. Influenza vaccine and 23-valent pneumococcal polysaccharide vaccine (PPSV23), separately or together, were significantly associated with decreased economic burden. Our study supports evidence on recommendations that COPD patients in China are offered both influenza vaccine and PPSV23.

Comparative Analysis on Communicable and Non-Communicable Diseases on Catastrophic Spending and Impoverishment in Tanzania.

The question of whether communicable or non-communicable diseases have higher economic effects on households is rarely explored from the global to local level despite of their significant contribution in increasing household catastrophic spending and impoverishment. To shed light into this, therefore, this paper comparatively examines the economic effects of communicable and non-communicable diseases in Tanzania by the use of Tanzania Panel Survey data of 2019/2020 which has been used to analyze different parameters to provide needful information. The empirical analysis employed probit, two-stage residual inclusion (2SRI), and control function approachf (CFA) helpful in controlling endogeneity issues. Findings showed that, comparatively, non-communicable diseases have higher economic effects in endangering households into catastrophic spending and impoverishment comparing to communicable diseases. Conclusively, neglecting developing countries to fights against multiplicative effects of these diseases alone will result in killing their economies since most of these countries depend on donors and household as a means of healthcare financing. However, this paper recommends for global initiatives in reducing the burden of disease by funding on palliative care costs and enhancing the availability of affordable health insurance schemes to reduce household economic burden.

Household economic burden of childhood severe pneumonia in Bangladesh: a cost-of-illness study

ObjectiveTo estimate household cost of illness (COI) for children with severe pneumonia in Bangladesh.DesignAn incidence-based COI study was performed for one episode of childhood severe pneumonia from a household perspective....

Assessing the household economic burden of non-communicable diseases in India: evidence from repeated cross-sectional surveys

BackgroundFinancing for NCDs is encumbered by out-of-pocket expenditure (OOPE) assuming catastrophic proportions. Therefore, it is imperative to investigate the extent of catastrophic health expenditure (CHE) on NCDs, which are burgeoning in India. Thus, our paper aims to examine the extent of CHE and impoverishment in India, in conjunction with socio-economic determinants impacting the CHE.MethodsWe used cross-sectional data from nationwide healthcare surveys conducted in 2014 and 2017–18. OOPE on both outpatient and inpatient treatment was coalesced to estimate CHE on NCDs. Incidence of CHE was defined as proportion of households with OOPE exceeding 10% of household expenditure. Intensity of catastrophe was ascertained by the measure of Overshoot and Mean Positive Overshoot Indices. Further, impoverishing effects of OOPE were assessed by computing Poverty Headcount Ratio and Poverty Gap Index using India’s official poverty line. Concomitantly, we estimated the inequality in incidence and intensity of catastrophic payments using Concentration Indices. Additionally, we delineated the factors associated with catastrophic expenditure using Multinomial Logistic Regression.ResultsResults indicated enormous incidence of CHE with around two-third households with NCDs facing CHE. Incidence of CHE was concentrated amongst poor that further extended from 2014(CI = − 0.027) to 2017–18(CI = − 0.065). Intensity of CHE was colossal as households spent 42.8 and 34.9% beyond threshold in 2014 and 2017-18 respectively with poor enduring greater overshoot vis-à-vis rich (CI = − 0.18 in 2014 and CI = − 0.23 in 2017–18). Significant immiserating impact of NCDs was unraveled as one-twelfth in 2014 and one-eighth households in 2017–18 with NCD burden were pushed to poverty with poverty deepening effect to the magnitude of 27.7 and 30.1% among those already below poverty on account of NCDs in 2014 and 2017–18 respectively. Further, large inter-state heterogeneities in extent of CHE and impoverishment were found and multivariate analysis indicated absence of insurance cover, visiting private providers, residing in rural areas and belonging to poorest expenditure quintile were associated with increased likelihood of incurring CHE.ConclusionSubstantial proportion of households face CHE and subsequent impoverishment due to NCD related expenses. Concerted efforts are required to augment the financial risk protection to the households, especially in regions with higher burden of NCDs.

An Overview of Women Entrepreneurship from Islamic Perspective

Islam has encouraged women to participate in entrepreneurial activities for economic prosperity and social growth. Nevertheless, their participation in economic activities is very lesser than men globally. Previously, the field of entrepreneurship has been regarded as a male dominant sector. Entrepreneurship flourishes due to economic, social, ethical, and environmental factors while the practice of Sharia principles works as a catalyst in this process. Women entrepreneurship helps in alleviating poverty and unemployment that leads to socio-economic prosperity in a country. The motivation of starting women businesses varies in different cultures and geographic regions. Women engagements in different business activities can not only empower them socially and financially but can also share the household economic burden with men. Furthermore, it will also help them to make their decisions independently. Their entrepreneurial income can be used for their children’s education, health, and the betterment of society. They can also use the option of partnership within the family for the financial and social network. The challenges faced by these women entrepreneurs can be handled with their family support. This review provides a general overview of concepts, motives, challenges, and the prospects of women entrepreneurship from an Islamic perspective.

Costs, burden and quality of life associated with informal caregiving for children with Lymphoma attending a tertiary hospital in Ghana

IntroductionPrimary family caregivers provide substantial support in the management of lymphoma, potentially affecting their quality of life and increasing household health care costs. Our aim was thus to determine the economic costs and quality of life of primary caregivers of children with lymphoma.MethodsThis cross-sectional study involved primary informal caregivers of children with lymphoma attending the pediatric cancer unit at Komfo Anokye Teaching Hospital. The study adopted a cost-of-illness approach to estimate the direct costs (medical and non- medical) incurred and indirect cost (productive losses) to caregivers over the one-month period preceding the data collection. Zarit Burden Interview was used to determine caregiver burden and EUROHIS-QoL tool was used to determine the quality of life of primary caregivers.ResultsThe average cost of managing lymphoma in children was estimated to be US$440.32, 97% of which were direct costs. On average, caregiver burden was 26.3 on the scale of 0 to 48. About 94% of caregivers reported high burden, with more males reporting high burden. Overall, average quality of life among caregivers was 2.20 on the 1 to 5 range. Approximately 85% of respondents reported low quality of life, with females reporting lower quality of life than males.DiscussionThis study shows that lymphoma is associated with substantial cost and increased burden, and affects quality of life of family caregivers. Future studies can explore the impact of social protection interventions (in the form of health insurance) to reduce the household economic burden of managing lymphoma in children.

Financial burden of HIV and TB among patients in Ethiopia: a cross-sectional survey

ObjectivesHIV and tuberculosis (TB) are major global health threats and can result in household financial hardships. Here, we aim to estimate the household economic burden and the incidence of catastrophic health expenditures (CHE) incurred by HIV and TB care across income quintiles in Ethiopia.DesignA cross-sectional survey.Setting27 health facilities in Afar and Oromia regions for TB, and nationwide household survey for HIV.ParticipantsA total of 1006 and 787 individuals seeking HIV and TB care were enrolled, respectively.Outcome measuresThe economic burden (ie, direct and indirect cost) of HIV and TB care was estimated. In addition, the CHE incidence and intensity were determined using direct costs exceeding 10% of the household income threshold.ResultsThe mean (SD) age of HIV and TB patient was 40 (10), and 30 (14) years, respectively. The mean (SD) patient cost of HIV was $78 ($170) per year and $115 ($118) per TB episode. Out of the total cost, the direct cost of HIV and TB constituted 69% and 46%, respectively. The mean (SD) indirect cost was $24 ($66) per year for HIV and $63 ($83) per TB episode. The incidence of CHE for HIV was 20%; ranges from 43% in the poorest to 4% in the richest income quintile (p<0.001). Similarly, for TB, the CHE incidence was 40% and ranged between 58% and 20% among the poorest and richest income quintiles, respectively (p<0.001). This figure was higher for drug-resistant TB (62%).ConclusionsHIV and TB are causes of substantial economic burden and CHE, inequitably, affecting those in the poorest income quintile. Broadening the health policies to encompass interventions that reduce the high cost of HIV and TB care, particularly for the poor, is urgently needed.

Economic Burden of Malaria and Associated Factors Among Rural Households in Chewaka District, Western Ethiopia.

BackgroundThere has been a remarkable decline in the burden of malaria in the past few decades in Ethiopia. However, malaria remains a major impediment to both health and economic development in Ethiopia, with 60% of the population at risk of contracting malaria. Hence, this study aimed to estimate the economic burden of malaria among rural households in Chewaka district, Buno Bedele zone, Oromia regional state, Western Ethiopia.MethodsCommunity-based cross-sectional study design was employed to estimate the economic burden of malaria at the household level from August 13 to September 2, 2018. A retrospective costing approach was employed, and cost was estimated from the perspective of households. The study included malaria expenditure of households during a one-year period (July 9, 2017 to July 9, 2018). Data were collected from 765 randomly selected households and analyzed using SPSS version 20. Multivariate logistic regression analysis was performed to identify predictors of the economic burden of malaria among rural households and all variables with P-value <0.05 were considered as statistically significant at 95% CI.ResultsOn average, each household comprised 2 malaria cases (SD 1.1) in the past one-year period and the prevalence of malaria in the study setting was 32% (95% CI, 30.5–33.2). The average annual income of households was US$626.7 (95% CI, 590.4–663.0). The mean annual cost of malaria illness to households was US$16 (95% CI, 14.8–17.2), and most of this cost (78%) was contributed by the indirect costs. In every household, on average, patients and companions or caregivers lost 3.4 productive workdays due to malaria illness, respectively. Fourteen households out of 100 spent more than 5% of their annual income on malaria treatment and hence, they were prone to high economic burden or catastrophic costs. Household level economic burden of malaria was determined by the sex and educational status of household head, means of transportation to treatment center, the episodes of malaria, the number of malaria “ill days“ and type of malaria diagnosis.ConclusionMalaria continues to significantly impose an economic burden on the rural households of Ethiopia. Hence, the national malaria program needs to recognize and address the catastrophic costs associated with malaria illness. Efforts should be made to ensure universal access to and utilization of malaria prevention, diagnosis, and treatment services.

The household economic burden of non-communicable diseases in 18 countries

BackgroundNon-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs....

Household economic burden and outcomes of patients with schizophrenia after being unlocked and treated in rural China.

Patients with severe mental disorders in low-resource settings have limited access to services, resulting in overwhelming caregiving burden for families. In extreme cases, this has led to the long-term restraining of patients in their homes. China underwent a nationwide initiative to unlock patients and provide continued treatment. This study aims to quantify household economic burden in families after unlocking and treatment, and to identify factors associated with increased burden due to schizophrenia. A total of 264 subjects were enrolled from three geographically diverse provinces in 2012. Subjects were patients with schizophrenia who were previously put under restraints and had participated in the 'unlocking and treatment' intervention. The primary outcome was the current household economic burden, obtained from past year financial information collected through on-site interview. Patient disease characteristics, treatment, outcomes and family caregiving burden were collected as well. Univariate and multivariate linear regression were used to construct risk factor models for indirect economic burden. After participating in the intervention, 85% of patients continued to receive mental health services, 70% used medication as prescribed and 80% were never relocked. Family members reported significantly decreased caregiving burden after receiving the intervention. Mean direct and indirect household economic burdens were CNY963 (US$31.7) and CNY11 724 (US$1670) per year, respectively, while family total income was on average CNY12 108 (US$1913) per year. Greater disease severity and poorer patient psychosocial function at time of study were found to be independent factors related to increased indirect burden. The 'unlocking and treatment' intervention has improved the lives of patients and families. Indirect burden due to disease is still a major economic issue that needs to be addressed, potentially through improving treatment and patient functioning. Our findings contribute to the unravelling and eventual elimination of chronic restraining of mentally ill patients in low-resource settings.

A cross-sectional study on economic burden of pulmonary tuberculosis cases from designated tuberculosis hospital

Objective: To understand the medical expenditure and related household economic burden of pulmonary tuberculosis (TB) patients receiving full course treatment in designated TB hospitals in China and identify the related factors. Method: A cross-sectional study was conducted in 535 consecutive TB patients receiving TB treatment from April 2017 to June 2017 in 5 designated TB hospitals in eastern and western China selected through stratified cluster sampling. A questionnaire was used to collect the information about patients' social economic characteristics and TB diagnosis and treatment expenditure. Results: The average total medical expenditure for TB treatment was 12 635.5 yuan (RMB), in which the direct medical expenditure accounted for 65.3% of the total. Nearly half of the total medical expenditure occurred in pre-treatment period. The expenditure in pre- treatment period was higher in the patients with low education level, newly treated patients, and initial sputum negative patients. The median (quartile) for the ratio of total medical expenditure to annual household income was 22%(10%-57%). Ordinal logistic regression analysis showed that low-level education background, lower household income, hospitalization and suffering from other chronic disease might increase the ratio of medical expenditure to annual household income. Conclusions: Medical expenditure for full course TB treatment is still high in patients in designated TB hospitals. It is suggested to strengthen the capability building of timely found and referral of TB patients in non- designated hospitals and improve fee reduction and exemption policy for some patients.

Taxes for health: evidence clears the air

Taxes for health: evidence clears the air

Household economic burden from seawater intrusion in coastal urban areas

ABSTRACTThis study quantifies the direct and indirect household economic burden of saltwater intrusion in Beirut, Lebanon, which experiences chronic water shortages. Incurred burdens include water purchase, reduction in the lifespan of household appliances, and building-level water treatment systems. Due to salinity, median household expenditure on water exceeds 6.5% of income, significantly higher than worldwide averages. A majority of affected respondents are willing to pay for mitigation measures to reduce salinity. The reported willingness to pay increased with education, income, salinity, and household expenditure on alternative water sources.

Economic burden of malaria on rural households in Gwanda district, Zimbabwe.

BackgroundMalaria is a serious public health problem in sub-Saharan Africa and is a leading cause of morbidity and mortality.AimTo estimate the economic burden of malaria in rural households.SettingThe study was conducted in Gwanda district of Matabeleland South in Zimbabwe. A total of five malarious wards and all their households were selected for the study frame, out of which 80 households were chosen using clinic records.MethodsA retrospective analysis of secondary data and a cross-sectional household survey were conducted to estimate the household economic burden of malaria. Eighty households from five rural wards were identified from the health facility malaria registers and followed up. A household was eligible for inclusion if there had been at least one reported malaria case during the period of 2013−2015. Interviewer administered questionnaires were used to collect household data on economic costs of malaria.ResultsOur findings showed that households spent an average of $3.22 and $56.60 for managing an uncomplicated and a complicated malaria episode respectively. A household lost an average of eight productive working days per each malaria episode resulting in an average loss of 24% of the monthly household income. An estimated 35%, mostly poorer households suffered catastrophic health expenditures.ConclusionMalaria imposes significant economic burdens particularly on the poorer and vulnerable households. Although there are no user fees at rural clinics, households incur other costs to manage a malaria patient. These costs are far worse for complicated cases.

The household economic burden for acute coronary syndrome survivors in Australia.

BackgroundStudies of chronic diseases are associated with a financial burden on households. We aimed to determine if survivors of acute coronary syndrome (ACS) experience household economic burden and to quantify any potential burden by examining level of economic hardship and factors associated with hardship.MethodsAustralian patients admitted to hospital with ACS during 2-week period in May 2012, enrolled in SNAPSHOT ACS audit and who were alive at 18 months after index admission were followed-up via telephone/paper survey. Regression models were used to explore factors related to out-of-pocket expenses and economic hardship.ResultsOf 1833 eligible patients at baseline, 180 died within 18 months, and 702 patients completed the survey. Mean out-of-pocket expenditure (n = 614) in Australian dollars was A$258.06 (median: A$126.50) per month. The average spending for medical services was A$120.18 (SD: A$310.35) and medications was A$66.25 (SD: A$80.78). In total, 350 (51 %) of patients reported experiencing economic hardship, 78 (12 %) were unable to pay for medical services and 81 (12 %) could not pay for medication. Younger age (18–59 vs ≥80 years (OR): 1.89), no private health insurance (OR: 2.04), pensioner concession card (OR: 1.80), residing in more disadvantaged area (group 1 vs 5 (OR): 1.77), history of CVD (OR: 1.47) and higher out-of-pocket expenses (group 4 vs 1 (OR): 4.57) were more likely to experience hardship.ConclusionSubgroups of ACS patients are experiencing considerable economic burden in Australia. These findings provide important considerations for future policy development in terms of the cost of recommended management for patients.