Prevalence and Predictors of Catastrophic Healthcare Expenditure in Indian Patients with Systemic Sclerosis

Introduction: Systemic sclerosis (SSc) is a multisystemic disease requiring multidisciplinary management, resulting in significant healthcare costs. In low- and middle-income countries (LMIC) like India, where out-of-pocket (OOP) spending is common and insurance coverage is limited, patients are at high risk of catastrophic health expenditure (CHE). Methods: In this cross-sectional study, SSc patients fulfilling 2013 ACR/EULAR criteria with ≥1 year follow-up were assessed for demographics, socioeconomic status (SES), annual household income, medication adherence and direct/indirect medical costs. CHE was defined as health expenditure exceeding 20% of annual household income. Predictors of CHE were evaluated using univariate and multivariate analysis. Results: A total of 100 patients were included, predominantly female (95), with a mean age of 49 ± 12 years. Diffuse cutaneous SSc was the predominant subtype (74%), and interstitial lung disease (ILD) was present in 64% of cases. Median annual household income was 3.6 lakhs. Medications accounted for the largest share of costs (49.2%), followed by laboratory services (18.9%). Patients using biologics ( P < .001) and with ILD ( P −.008) had significant differences in median direct cost. CHE occurred in 33% of patients. Total household income and medication costs were independently associated with CHE in the multivariate analysis. Low medication adherence was observed in 29 patients, of whom 10 patients had financial constraints, reported more frequently among lower- and middle-class patients. Conclusion: One-third of patients experienced CHE and poor medication adherence, with financial constraints as a key driver. Internal organ involvement and biologic therapy increased direct medical expenditure, whilst household income was the single most important predictor of CHE. Targeted support and robust adherence-enhancing strategies are crucial for higher-risk patients.