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COST OF INTENSIVE CARE IN INDIA

Published online by Cambridge University Press:  09 September 2016

John Victor Peter ,
Kurien Thomas ,
Lakshmanan Jeyaseelan ,
Bijesh Yadav ,
Thomas Isiah Sudarsan ,
Jony Christina ,
Anna Revathi ,
K R John  and
Thambu David Sudarsanam
John Victor Peter
Affiliation:
Medical Intensive Care Unit, Christian Medical Collegepeterjohnvictor@yahoo.com.au
Kurien Thomas
Affiliation:
Department of Medicine, Pondicherry Institute of Medical Sciences (PIMS)
Lakshmanan Jeyaseelan
Affiliation:
Department of Biostatistics, Christian Medical College
Bijesh Yadav
Affiliation:
Department of Biostatistics, Christian Medical College
Thomas Isiah Sudarsan
Affiliation:
Medical Intensive Care Unit, Christian Medical College
Jony Christina
Affiliation:
Clinical Epidemiology Unit, Christian Medical College
Anna Revathi
Affiliation:
Clinical Epidemiology Unit, Christian Medical College
K R John
Affiliation:
SRM Medical College
Thambu David Sudarsanam
Affiliation:
Department of Medicine, Christian Medical College
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Abstract

Objectives: The majority of patients in India access private sector providers for curative medical services. However, there is scanty information on the cost of treatment of critically ill patients in this setting. The study evaluates the cost and extent of financial subsidy required for patients admitted to an intensive care unit (ICU) in India.

Methods: Data on direct medical, direct nonmedical, and indirect cost were prospectively collected from critically ill patients admitted to a tertiary teaching hospital in India. Willingness-to-pay (WTP) amount was obtained from the next-of-kin following admission and the actual cost paid by the family at discharge was recorded.

Results: The main diagnoses (n = 499) were infection (26 percent) and poisoning (21 percent). The mean APACHE-II score was 13.9 (95 percent confidence interval [CI], 13.3–14.5); 86 percent were ventilated. ICU stay was 7.8 days (95 percent CI, 7.3–8.3). Hospital mortality was 27.9 percent. Direct medical cost accounted for 77 percent (US$ 2164) of the total treatment cost (US$ 2818). Indirect cost and direct nonmedical cost contributed to 19 percent (US$ 547.5) and 4 percent (US$ 106.5), respectively. Average total and daily ICU cost were US$ 1,897 and US$ 255, respectively. Although the family's WTP was 53 percent (US$ 1146; 95 percent CI, 1090–1204) of direct medical cost, their final contribution was 67.7 percent (US$ 1465; 95 percent CI, 1327–1604).

Conclusions: The cost of an ICU admission in our setting is US$ 2818. Although the family's contribution to expenses exceeded their initial WTP, a substantial subsidy (33 percent) is still required. Alternate financing strategies for the poor and optimization of ICU resources are urgently required.

Keywords

Direct medical costIndirect costWillingness-to-payIntensive careHealth economics
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 32 , Issue 4 , 2016 , pp. 241 - 245
Copyright
Copyright © Cambridge University Press 2016 

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