Objective: A cost of illness study was conducted with aims to asses various cost of acute stroke care and its determinants among beneficiary (patients enrolled in any social security scheme) and non beneficiary (patients not enrolled in any social security scheme) of various social security schemes. Method: A cross-sectional study was conducted at government hospitals in western Rajasthan from March to May 2019. All consecutive stroke patients were enrolled during study period. Data related to socio-demographic, disease-related and cost-related data was collected by direct patient and main caregiver’s interview. Primary study outcome was description of direct and indirect cost of acute stroke care among beneficiary and non beneficiary patients. Secondary outcome was description of determinants of cost or significant cost-driven variables. Results: Total of 126 stroke patients were enrolled in 3 months. Mean age was 57.67 ± 15.0 and male: female ratio was 82:44. Both beneficiary and non-beneficiary patients were similar in baseline characteristic except monthly income (P < 0.01) Mean hospital stay was 6.52 ± 2.23 Total out of pocket direct cost among beneficiary was INR 12727.21 [95% C.I. 8658.50, 16795.92] and among non beneficiary was INR 23649.68 [95%C.I. 18591.37, 28707.99]. There was significant difference indirect cost of beneficiary and non-beneficiary patients (P < 0.01). Mean Indirect cost (wages loss) among beneficiary was INR 12414.75 [95% C.I. 9691.13, 15138.37] and among non-beneficiary was INR 16460 [95% C.I. 13044.81, 19875.19]. There was no significant difference in Indirect cost of beneficiary and non-beneficiary patients (P = 0.06). Monthly income, stroke severity (modified Rankin score) and hospital stay were significant direct cost determinants. Conclusion: Public health insurance scheme reduces direct cost of acute stroke care significantly. Severity of stroke and prolonged hospital stay were main cost-driven variables.


中文翻译：

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西拉贾斯坦邦三级护理医院社会保障计划受益人和非受益人急性中风护理的经济负担


目的：进行疾病成本研究，旨在评估各种社会保障的受益人（参加任何社会保障计划的患者）和非受益人（未参加任何社会保障计划的患者）中急性卒中护理的各种成本及其决定因素计划。方法：一项横断面研究于 2019 年 3 月至 2019 年 5 月在拉贾斯坦邦西部的政府医院进行。所有连续中风患者均在研究期间入组。与社会人口统计、疾病相关和成本相关数据相关的数据是通过直接患者和主要护理人员的访谈收集的。主要研究结果是描述受益和非受益患者急性卒中护理的直接和间接费用。次要结果是对成本决定因素或重要成本驱动变量的描述。结果： 3 个月内共有 126 名卒中患者入组。平均年龄为 57.67 ± 15.0，男女比例为 82:44。除月收入外，受益人和非受益人的基线特征相似（P< 0.01) 平均住院时间为 6.52 ± 2.23 受益人的自付费用直接费用总额为 12727.21 卢比 [95% CI 8658.50, 16795.92]，非受益人为 23649.68 卢比 [95%CI 18591.37, 28707.99]。受益患者与非受益患者的间接费用差异有统计学意义（P <0.01）。受益人的平均间接成本（工资损失）为 12414.75 卢比 [95% CI 9691.13, 15138.37]，非受益人的平均间接成本为 16460 卢比 [95% CI 13044.81, 19875.19]。受益患者与非受益患者的间接费用差异无统计学意义（P =0.06）。月收入、中风严重程度（改良 Rankin 评分）和住院时间是重要的直接成本决定因素。结论：公共健康保险计划显着降低了急性卒中护理的直接成本。中风的严重程度和住院时间延长是主要的成本驱动变量。