title: Economic burden of chronic conditions among households in Myanmar: the case of angina and asthma.
abstract: BACKGROUND
  Non-communicable diseases (NCDs) are becoming a major source of the national disease burden in Myanmar with potentially serious economic implications.
  
  
  METHODS
  Using data on 5484 households from the World Health Survey (WHS), this study assessed the household-level economic burden of two chronic conditions, angina and asthma, in Myanmar. Propensity score matching (PSM) and coarsened exact matching (CEM) methods were used to compare household out-of-pocket (OOP) spending, catastrophic and impoverishment effects, reliance on borrowing or asset sales to finance OOP healthcare payments and employment among households reporting a member with angina (asthma) to matched households, with and without adjusting for comorbidities. Sensitivity analyses were carried out to assess the impacts of alternative assumptions on common support and potential violations of the assumption of independence of households being angina (asthma) affected and household economic outcomes, conditional on the variables used for matching (conditional independence).
  
  
  RESULTS
  Households with angina (asthma) reported greater OOP spending (angina: range I$1.94-I$4.31; asthma: range I$1.53-I$2.01) (I$1 = 125.09 Myanmar Kyats; I$=International Dollar) almost half of which was spending on medicines; higher rates of catastrophic spending based on a 20% threshold ratio of OOP to total household spending (angina: range 6-7%; asthma: range 3-5%); greater reliance on borrowing and sale of assets to finance healthcare (angina: range 12-14%; asthma: range 40-49%); increased medical impoverishment and lower employment rates than matched controls. There were no statistically differences in OOP expenses for inpatient care between angina-affected (asthma-affected) households and matched controls. Our results were generally robust to multiple methods of matching. However, conclusions for medical impoverishment impacts were not robust to potential violations of the conditional independence assumption.
  
  
  CONCLUSIONS
  Myanmar is expanding public spending on health and has recently launched an innovative programme for supporting hospital-based care for poor households. Our findings suggest the need for interventions to address OOP expenses associated with outpatient care (including drugs) for chronic conditions in Myanmar's population.
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, 99 Commercial Road, The Alfred Centre, Melbourne, Victoria 3004, Australia, Department of Health, Ministry of Health, Government of Myanmar, 4 Zeya Htani Rd, Nay Pyi Taw, Myanmar 10528 and.
authors.forename: Soe
authors.initials: S
authors.lastname: Htet
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, 99 Commercial Road, The Alfred Centre, Melbourne, Victoria 3004, Australia, Equity and Health Systems, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka 1212, Bangladesh.
authors.forename: Khurshid
authors.initials: K
authors.lastname: Alam
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, 99 Commercial Road, The Alfred Centre, Melbourne, Victoria 3004, Australia, ajay.mahal@monash.edu.
authors.forename: Ajay
authors.initials: A
authors.lastname: Mahal
mesh_terms: D000293:Adolescent; D000328:Adult; D000787:Angina Pectoris / Q000191:economics* / Q000628:therapy; D001249:Asthma / Q000191:economics* / Q000628:therapy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D017281:Cost of Illness; D005191:Family Characteristics; D005260:Female; D005382:Financing, Personal; D005102:Health Expenditures; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Angina; Myanmar; asthma; coarsened exact matching; economic burden; households; propensity score matching