Economic burden and catastrophic health expenditure associated with topical corticosteroid misuse at a tertiary care hospital in India

Abstract Introduction: Topical corticosteroid misuse is a growing public health concern in India. While dermatological adverse effects are well documented, the patient-level economic burden and catastrophic health expenditure (CHE) remain underexplored. Methods: This cross-sectional, hospital-based observational study was conducted over 6 months at a tertiary care dermatology outpatient department. Patients presenting with adverse effects attributable to topical corticosteroid misuse were enrolled. Data on sociodemographic characteristics, patterns of misuse, adverse drug reactions (ADRs), and economic parameters were collected. Costs were categorized into direct and indirect cost. CHE was assessed using a per-capita income approach, with thresholds set at 10% and 20% of monthly per-capita income. Lorenz curves and Gini coefficients were used to assess income inequality. Results: A total of 316 patients were included. The median monthly family income was ₹25,000 (interquartile range [IQR] ₹4500) and the median per-capita income was ₹4700 (IQR ₹2156). The median total out-of-pocket cost was ₹2840 (IQR ₹1494), with treatment of ADRs contributing more than the cost of topical corticosteroid products themselves. CHE exceeding 10% of monthly per-capita income was observed in 94 patients (29.74%), while 58 patients (18.35%) exceeded the 20% threshold. Lorenz curve analysis demonstrated substantial income inequality, with higher financial vulnerability among lower-income individuals and female patients. Conclusion: In this study, we found that nearly one in three patients (29.7%) presenting with ADRs due to topical corticosteroid misuse experienced CHE at the 10% per capita income threshold. Treatment of these ADRs was the primary driver of direct costs. Strengthening regulatory oversight on the availability of topical corticosteroids may help prevent this clinical and economic burden.