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Patients driven into poverty by the high cost of treating ankylosing spondylitis: Study

Evaluation shows the economic cost and the immediate need for policy changes.

Researchers from the Department of Medicine at Maulana Azad Medical College and Lok Nayak Hospital in Delhi recently reported the substantial financial burdens that patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) in North India face, underscoring the urgent need for legislative changes.

According to the study that was published in the Indian Journal of Rheumatology, RA patients spend ₹51,741 annually on average, while AS individuals spend ₹41,379 on average.

Indirect costs, particularly lower labour productivity, significantly exacerbate these financial problems. It also revealed that catastrophic health expenditures (CHE) frequently result from out-of-pocket expenses (OOPE), which have a negative effect on patients' quality of life and financial security.

Too little health insurance makes many people seek expensive private treatment. Chronic inflammatory rheumatological disease, ankylosing spondylitis (AS), is severely burdening sufferers in North India, driving many of them into poverty.

A tertiary care hospital's alarming new data on the cost of illness (COI) and out-of-pocket expenses (OOPE) associated with AS and rheumatoid arthritis (RA) highlights the urgent need for targeted legislative measures to alleviate these financial struggles.

Using the human capital method and a prevalence-based, bottom-up methodology, the retrospective cross-sectional study of 87 individuals estimated the direct and indirect costs of RA and AS.

While RA patients had an even greater burden at ₹51,741 per person, AS individuals had an average yearly COI of ₹41,379 per person; the adjustment of these numbers using the Consumer Price Index for 2021 reflected the significant financial burden these diseases inflict, the authors of the study noted.

The main drivers of the COI were direct expenses, which amounted to 58.84% (24,348) for AS patients and 65.21% (33,743) for RA patients, including those for drugs and investigations.

They further found that investigation fees were the largest single element of direct expenditures for AS patients, emphasising the high cost of required diagnostic procedures like MRI scans.

However,  for RA sufferers, the biggest out of pocket expenditure was on their prescriptions.
In both cases, indirect expenses were also significant, which were mostly caused by lower work output, while indirect expenditures for AS patients were almost exactly the same as direct costs, coming to ₹17,030 annually.

According to the study, patients with RA and AS had impairments of almost 50% in both job productivity and activity, which had a major impact on their capacity to work and go about their everyday lives.

Patients paid a large amount of their own medical expenses for both AS and RA directly: 39.2% (9,544) for AS and 54.95% (18,544) for RA.

In many homes, this high OOPE results in catastrophic health expenditure (CHE), which affects 14.92% of RA patients and 6.67% of AS patients.

The survey also revealed that patients frequently used distress financing to pay for medical expenses, including taking out loans, selling real estate and valuables, and even moving to places with easier access to healthcare.

Such steps put a great deal of psychological burden on the patients' families, in addition to taxing their money, beyond only direct medical expenses, the economic toll of AS and RA affects the quality of life for the patients as well as the stability of their families' finances.

Young men between the ages of 20 and 40, who are usually at their peak of productivity, constitute the majority of AS sufferers, while for patients as well as the larger economy, the decrease in productivity and rising medical costs have grave consequences for patients and the larger economy

The report clearly showed how inadequate health insurance coverage exacerbates patients' financial burden.

At least thirty percent of Indians lack health insurance, forcing many to seek treatment in the more expensive private healthcare system, which raises OOPE and restricts access to essential medical care.

The paper proposes a number of legislative actions to lessen these financial strains. Health insurance coverage can include comprehensive care for chronic diseases like RA and AS, which can significantly reduce out of pocket expenses and OOPE and CHE.

Especially in rural and semi-urban regions, improving the infrastructure of public healthcare will increase access to reasonably priced diagnostic and treatment services, thereby lowering the need for costly private care.

The authors argued that subsidies for necessary drugs and diagnostic procedures will reduce direct medical expenses and increase treatment affordability.

Putting money into mobility aids and physical therapy, among other rehabilitation treatments, can improve patients' quality of life and save long-term medical costs.

Finally, the implementation of economic support programmes can alleviate the financial burden on families affected by chronic diseases and prevent poverty.

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