Cost of diabetes and hypertension services delivered in primary and secondary-level government facilities in Punjab, India

The recent rise of diabetes and hypertension in India has motivated initiatives to enhance screening and management of these conditions within the public health care system. The associated healthcare costs of screening and management may inform policy planning and scaling initiatives, yet costs are not well documented in this setting. We conducted a micro-costing study to estimate the cost per visit and total annual cost of outpatient diabetes and hypertension care in primary and secondary level health facilities in northern India. Data collection took place in rural Punjab state in 2019 and included a facility survey and patient time and motion study at 1 district hospital (DH), 2 community health centres (CHC), and 8 primary health centres (PHC). Costs per visit were compared by visit type and facility level using Dunn’s test. We used one-way, deterministic sensitivity analyses to examine the potential impact of uncertainty on findings. Costs are expressed in 2019 INT$ and INR₹ from a health system perspective. Average per-visit costs were higher for diabetes (range: INT$12.54–14.36) and co-morbid hypertension and diabetes (range: INT$13.11–15.04) visits than those for hypertension (range: INT$9.04–12.73) across facility levels. The resource categories that drove visit-specific costs were medication (30.4% of costs) and staff (28.9%). At a facility-level, medication and investigation costs tended to be higher for visits at CHCs than those at PHCs and the DH. Total annual costs were highest at the DH (INT$96,114.66) due to the larger number of patients served. Sensitivity analyses confirmed that per-visit costs were most sensitive to medication price and staff salary. The cost of services delivered for diabetes and hypertension at Indian public sector facilities varied by facility level. Higher costs at CHC and DH levels may reflect the role of these facilities in providing more specialized services, serving medically complex patient populations, or may indicate inefficiencies in service organization. Findings of this analysis may inform health system planning to expand coverage of service delivery.