Intersecting illnesses and incomes: A mixed-methods inquiry into the cost of Hypertension and diabetes in rural households

Hypertension (HTN) and Type 2 Diabetes Mellitus (T2DM) impose a significant economic burden globally, entailing high direct and indirect medical and non-medical costs. Using a mixed-methods approach, this study aimed to estimate the medical and non-medical costs and the socio-economic consequences associated with managing co-existing HTN and T2DM in a rural community in Karnataka, India. A mixed-methods study was conducted among 83 patients diagnosed with both HTN and T2DM in a rural area of Karnataka. Quantitative data on healthcare-related costs were collected using a structured questionnaire, while qualitative insights were gathered through two focus group discussions (FGDs) with patients. Data were analysed using SPSS v 29.0, and Qualitative analysis was conducted using the QDA Miner software tool 6. The median monthly direct medical cost was ₹570 (IQR: ₹364–₹986.5) for oral medications and ₹500 (IQR: ₹400–₹1200) for injectables and lab investigations. Hospitalisation imposed a substantial burden with a median cost of ₹20,000 (IQR: ₹12,500–₹45,000). Non-medical costs included stay (₹1500; IQR: ₹1000–₹2050), travel (₹300; IQR: ₹200–₹500), and food (₹250; IQR: ₹200–₹1000). Indirect costs from wage loss were significant, with a median daily income loss of ₹500 (IQR: ₹500–₹650) for patients and ₹600 (IQR: ₹500–₹650) for caregivers. Qualitative findings revealed recurring financial stress, disrupted education and savings, coping mechanisms (borrowing, missing medicines), and distress due to stock-outs at government facilities. Managing HTN and T2DM imposes a substantial financial burden on rural households, exacerbated by limited access to affordable care and indirect income losses.