Direct and indirect costs associated with state of health in patients receiving home-based respiratory support and oxygen therapy

Objective. To assess direct and indirect costs caused by state of health of patients suffering from chronic respiratory failure (CRF) and receiving respiratory support and oxygen therapy (RSOT) at home but not directly related to participation of patients in the study (i.e., with provision of RSOT). Material and methods. We analyzed direct medical, direct non-medical and indirect costs caused by state of health of patients suffering from CRF and receiving RSOT at home, but not directly related to participation of patients in the study (i.e., with provision of RSOT). We extracted data from patients’ diaries and individual registration cards. In accordance with study protocol, these diaries and cards contained information about medical and social assistance, purchase of medical devices, temporary disability with indication of funding source (compulsory medical insurance system (CMI) or personal funds of patients and their families). Costs of medical care at the expense of CMI were based on tariffs and standards of financial expenses in Moscow. Costs incurred from personal funds were received from diaries. Direct non-medical costs included transportation costs, professional care at home, and payments related to temporary disability. Indirect costs were estimated as losses of gross domestic product (GDP) due to temporary disability of patients of working age. Cost data was collected and processed in subgroup of 65 patients (66.3% of 98 participating in the study). Total costs and weighted average costs per a patient were determined for study period (8.7 months) and calculated on annual basis. Results. Total costs for the entire subgroup throughout study period amounted to RUB 42.6 million, including RUR 6.4 million (14.9%) of direct medical costs, RUB 9.8 million (23.0%) of direct non–medical costs and RUB 26.5 million (62.1%) of indirect costs as GDP losses. Maximum share accounted to inpatient medical care in the structure of direct medical costs. About 9% of direct medical expenses and 38% of direct non-medical expenses were paid from personal funds. Weighted mean cost per a patient per year was as follows: direct medical costs — RUB 34.2 thousand; direct non–medical costs — RUB 200.9 thousand, indirect costs — RUB 642.9 thousand. Conclusion. Health status in patients with chronic respiratory failure receiving respiratory support and oxygen therapy at home represents a significant economic burden for society and state, primarily due to indirect costs associated with disability of working-age patients. These data may be used to analyze budgetary impact of medical interventions in this patient group.