When injury costs too much: the catastrophic costs for spinal cord injury in Iran

The main objective of this study was to determine the percentage of families experiencing catastrophic costs as a result of spinal cord injury. Patients with spinal cord injuries often encounter significant expenses related to treatment, rehabilitation, and caregiving. Catastrophic expenditures are the direct consequence of the lack of effective health insurance. This financial burden, along with the potential for catastrophic costs, presents a serious challenge for these individuals. Data were obtained from the International Spinal Cord Injury Survey in Iran (InSCI-IR), which included 291 patients from Guilan Province. The study collected detailed information on direct and indirect costs, changes in household income after spinal cord injury, coping strategy earnings, and the household wealth index. Catastrophic costs were calculated using multiple approaches, including the household budget share method, disease-specific cost calculations, analyses excluding coping earnings, income estimation based on asset ownership, and Xu’s method based on capacity to pay. In addition, regression models and sensitivity analyses were conducted. The prevalence of households experiencing catastrophic costs due to spinal cord injury (SCICC) was 45.0%, ranging from 22.0% to 49.4% depending on the calculation method. Factors associated with catastrophic costs included gender (female patients were less likely to experience catastrophic costs, β = -0.75), presence of complete SCI (β = 1.53) or incomplete SCI (β = 1.46), household size (larger households were less likely to experience catastrophic costs, β = -0.27), higher activity participation levels (β = 0.29), greater independence scores (associated with a lower likelihood of catastrophic costs, β = -0.16), and the occurrence of pressure ulcers (β = 0.90). Health insurance strategies that enhance cost-sharing arrangements and broaden coverage for underrepresented services, along with preventive measures aimed at managing pressure ulcers and pain, can significantly mitigate the incidence of catastrophic financial burdens faced by patients with spinal cord injuries.