Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis |
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Authors: | Everardo Álvarez-Hernández Ingris Peláez-Ballestas Annelies Boonen Janitzia Vázquez-Mellado Adolfo Hernández-Garduño Fernando Carlos Rivera Leobardo Teran-Estrada Lucio Ventura-Ríos César Ramos-Remus Cassandra Skinner-Taylor Maria Victoria Goycochea-Robles Ana Guislaine Bernard-Medina Rubén Burgos-Vargas |
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Affiliation: | 1. Rheumatology Unit, Hospital General de México, Mexico City, Mexico;2. Rheumatology Department, Maastricht University Medical Centre, The Netherlands;3. Faculty of Medicine, Universidad Nacional Autonoma de México, México, Mexico;4. Department of Pediatrics, Hospital Universitario “José Eleuterio Gonzalez”, Monterrey, Nuevo León, Mexico;5. RAC Salud Consultores S.A. de C.V., México DF, Mexico;6. Hospital General de Zona 1, IMSS, Morelia, Michoacán, Mexico;7. Hospital Central Sur, PEMEX, México DF, Mexico;8. Centro Médico Nacional de Occidente IMSS, Jalisco, Mexico;9. Department of Rheumatology, Hospital Universitario “José Eleuterio Gonzalez”, Monterrey, Nuevo León, Mexico;10. Research Unit, Colegio Mexicano de Reumatología, México DF, Mexico;11. Hospital Civil, SS, Guadalajara, Jalisco, Mexico |
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Abstract: | BackgroundThe cost of certain diseases may lead to catastrophic expenses and impoverishment of households without full financial support by the state and other organizations.ObjectiveTo determine the socioeconomic impact of the rheumatoid arthritis (RA) cost in the context of catastrophic expenses and impoverishment.Patients and methodsThis is a cohort-nested cross-sectional multicenter study on the cost of RA in Mexican households with partial, full, or private health care coverage. Catastrophic expenses referred to health expenses totaling >30% of the total household income. Impoverishment defined those households that could not afford the Mexican basic food basket (BFB).ResultsWe included 262 patients with a mean monthly household income (US dollars) of $376 (0–18,890.63). In all, 50.8%, 35.5%, and 13.7% of the patients had partial, full, or private health care coverage, respectively. RA annual cost was $ 4653.0 per patient (65% direct cost, 35% indirect). RA cost caused catastrophic expenses in 46.9% of households, which in the logistic regression analysis were significantly associated with the type of health care coverage (OR 2.7, 95%CI 1.6–4.7) and disease duration (OR 1.024, 95%CI 1.002–1.046). Impoverishment occurred in 66.8% of households and was associated with catastrophic expenses (OR 3.6, 95%CI 1.04–14.1), high health assessment questionnaire scores (OR 4.84 95%CI 1.01–23.3), and low socioeconomic level (OR 4.66, 95%CI 1.37–15.87).ConclusionThe cost of RA in Mexican households, particularly those lacking full health coverage leads to catastrophic expenses and impoverishment. These findings could be the same in countries with fragmented health care systems. |
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