OBJECTIVES

: Treatment of chronic hepatitis C viral(HCV) infection causes high out-of-pocket(OOP) expenditure. A study was conducted to estimate the OOP expenditure and incidence of catastrophic health payment(CHP) among patients with hepatitis C-relevant disease stages.

METHODS

: A cross-sectional study was conducted at University Malaya Medical Centre(UMMC) among patients who attended out-patient visit and admitted to ward form March to September 2018. Face-to-face interviews were conducted to obtain data on household characteristics and annual healthcare expenditures. The households were categorized based on median income groups into Top 20(T20), Middle 40(M40) and Bottom 40(B40). CHP was defined as OOP health payment exceeding 10% of household income. All costs were reported in Malaysian Ringgit(RM)[conversion rate of US$1=RM3.93, price year 2018].

RESULTS

: 135 households were included. The distributions of household income groups were 10%, 22% and 68% for T20, M40 and B40 respectively. In all income groups, direct medical expenditure such as laboratory investigations, traditional and complementary medicine(TCM) and HCV complications-related admission were the main drivers. For households in T20, the mean annual household expenditure was RM 3,058, which was 1% of mean income and none experienced CHP. For households in M40, the mean expenditure was RM 9,551, which comprised of 10% of income. 27% of M40 experienced CHP. In B40 households, the mean expenditure was RM 4,891, which comprised of 28% of income and caused CHP in 35% of households.

CONCLUSIONS

: Patients with HCV infection are at risk of experiencing CHP especially in B40 group. The availability of generic drugs for HCV treatment through recent compulsory licensing agreement could reduce downstream health spending and financial burden due to its high effectiveness to cure patients. Expenditure on TCM was also found to be high and therefore health education and promotion to increase knowledge and awareness on appropriate use of TCM could help to contain excessive healthcare expenditure.