Prevalence and Predictors of Catastrophic Healthcare Expenditure in Indian Patients with Systemic Sclerosis
Hridya Shenoy, Poornima Kotapati, Sakir Ahmed, Sarah Khadeeja N, Joicy Jose, Aparna R. Menon, Padmanabha Shenoy DIntroduction:
Systemic sclerosis (SSc) is a multisystemic disease requiring multidisciplinary management, resulting in significant healthcare costs. In low- and middle-income countries (LMIC) like India, where out-of-pocket (OOP) spending is common and insurance coverage is limited, patients are at high risk of catastrophic health expenditure (CHE).
Methods:
In this cross-sectional study, SSc patients fulfilling 2013 ACR/EULAR criteria with ≥1 year follow-up were assessed for demographics, socioeconomic status (SES), annual household income, medication adherence and direct/indirect medical costs. CHE was defined as health expenditure exceeding 20% of annual household income. Predictors of CHE were evaluated using univariate and multivariate analysis.
Results:
A total of 100 patients were included, predominantly female (95), with a mean age of 49 ± 12 years. Diffuse cutaneous SSc was the predominant subtype (74%), and interstitial lung disease (ILD) was present in 64% of cases. Median annual household income was 3.6 lakhs. Medications accounted for the largest share of costs (49.2%), followed by laboratory services (18.9%). Patients using biologics (
Conclusion:
One-third of patients experienced CHE and poor medication adherence, with financial constraints as a key driver. Internal organ involvement and biologic therapy increased direct medical expenditure, whilst household income was the single most important predictor of CHE. Targeted support and robust adherence-enhancing strategies are crucial for higher-risk patients.