Out-of-pocket and catastrophic health expenditure among patients of sexually transmitted infections at a tertiary care center: A cross-sectional study

Abstract

Context: Economic burden imposed by sexually transmitted infections (STIs) is substantial in low-middle-income countries like India, in spite of the fact that national programs for controlling STIs are operational. Aims: The aim of this study was to estimate the out-of-pocket expenses and catastrophic health expenditure (CHE) incurred by patients of STIs and analyze expenditure pattern in relation to various clinical and sociodemographic characteristics. Settings and Design: This was a hospital-based cross-sectional study among patients attending Suraksha Clinic. Subject and Methods: The study was conducted among patients aged ≥18 years. Data were collected regarding various direct and indirect expenses incurred, after adjusting any reimbursement or waive off. Total costs exceeding 10% of annual household income were considered catastrophic. Stepwise regression analysis was used to analyze predictors, and P < 0.05 was considered statistically significant. Results: Out of 157 patients, most were suffering from herpetic ulcers (27.4%). The median and interquartile range (IQR) for total OOPE of STI management was `1950 (IQR 1035–5725). Direct expenditure constituted major expenses with a median of `1850 (IQR 787.50–5385.0). The cost of STI management was catastrophic in 15.2% of cases. Lower socioeconomic status, longer traveling distance, overnight stay as a part of seeking treatment at Suraksha Clinic, previous history of other than allopathic treatment, and quack consultation were found to be independent predictors of CHE. Conclusions: Despite free diagnostic and treatment services to STI patients under the National AIDS Control Programme, many incurred considerable costs and catastrophic expenditure toward STI care. Better outreach of health services is required to maximize STI control and lower financial morbidity.