Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis.
BACKGROUND
The cost of certain diseases may lead to catastrophic expenses and impoverishment of households without full financial support by the state and other organizations.


OBJECTIVE
To determine the socioeconomic impact of the rheumatoid arthritis (RA) cost in the context of catastrophic expenses and impoverishment.


METHODS
This 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).


RESULTS
We 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 $ 5534.8 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).


CONCLUSIONS
The 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.
Rheumatology Unit, Hospital General de México, Mexico City, Mexico.
Everardo
E
Álvarez-Hernández
Ingris
I
Peláez-Ballestas
Annelies
A
Boonen
Janitzia
J
Vázquez-Mellado
Adolfo
A
Hernández-Garduño
Fernando Carlos
FC
Rivera
Leobardo
L
Teran-Estrada
Lucio
L
Ventura-Ríos
César
C
Ramos-Remus
Cassandra
C
Skinner-Taylor
Maria Victoria
MV
Goycochea-Robles
Ana Guislaine
AG
Bernard-Medina
Rubén
R
Burgos-Vargas
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000191:economics / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000191:economics*; D002388:Catastrophic Illness / Q000191:economics; D015331:Cohort Studies; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005190:Family; D005260:Female; D005523:Food Supply / Q000191:economics; D005102:Health Expenditures; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health; D008297:Male; D017057:Medically Uninsured; D008800:Mexico; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D011203:Poverty; D017149:Private Sector / Q000191:economics; D011788:Quality of Life; D012943:Social Security / Q000191:economics; D011795:Surveys and Questionnaires; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents