J. Pharm. Pharmacogn. Res., vol. 13, no. 1, pp. 274-283, Jan-Feb 2025.
DOI: https://doi.org/10.56499/jppres24.2036_13.1.274Original Article
Chronic disease costs from a patient’s perspective: A survey of patients with stroke, heart disease, and chronic kidney disease visiting a district hospital in Indonesia
[Costos de las enfermedades crónicas desde la perspectiva del paciente: Una encuesta a pacientes con accidente cerebrovascular, enfermedad cardíaca y enfermedad renal crónica que visitaron un hospital de distrito en Indonesia]
Dwi Endarti1*, Tri Murti Andayani2, Anna Wahyuni Widayanti1, Syifaur Rohmah3, Resi Rizki Banjarani3, Nurul Adzkia Ghearizky3
1Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Sekip Utara, Yogyakarta, Indonesia.
2Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Sekip Utara, Yogyakarta, Indonesia.
3Master Program in Pharmacy Management, Faculty of Pharmacy, Universitas Gadjah Mada, Sekip Utara, Yogyakarta, Indonesia.
*E-mail: endarti_apt@ugm.ac.id
Abstract
Context: Chronic disease treatment can lead to catastrophic costs. Although most direct medical costs are covered by the National Health Insurance, direct nonmedical and indirect costs may be burdensome for patients.
Aims: To estimate the cost of chronic diseases from a patient’s perspective.
Methods: A total of 315 patients with stroke (n = 105), heart disease (n = 108), and chronic kidney disease (n = 102) visiting a district hospital in Yogyakarta Province in Indonesia were included in this study. Data were collected through interviews and analyzed using descriptive statistics. Significant differences in mean costs between different groups seeking healthcare facilities were determined using the Mann–Whitney U test.
Results: The estimated total out-of-pocket (OOP) costs per patient within three months were IDR 3,411,662 (USD 227.4), IDR 632,665 (USD 42.2), and IDR 3,227,951 (USD 215.2) for stroke, heart disease, and chronic kidney disease, respectively. OOP costs for the three diseases accounted for 9–49% of minimum regional wages. Indirect costs were the highest costs contributing to the total OOP cost (33–64%), followed by direct medical costs (12–57%) and direct nonmedical costs (5–33%). Patients seeking additional treatment at other healthcare facilities tended to have significantly higher costs.
Conclusions: This study showed that chronic diseases put a relatively high economic burden on patients. Additionally, seeking more healthcare facilities tends to increase costs.
Keywords: catastrophic disease; cost of illness; economic burden; out-of-pocket cost.
Resumen
Contexto: El tratamiento de enfermedades crónicas puede generar costos catastróficos. Aunque la mayoría de los costos médicos directos están cubiertos por el Seguro Nacional de Salud, los costos directos no médicos e indirectos pueden resultar onerosos para los pacientes.
Objetivos: Estimar el costo de las enfermedades crónicas desde la perspectiva del paciente.
Métodos: Se incluyó en este estudio a un total de 315 pacientes con accidente cerebrovascular (n = 105), enfermedad cardíaca (n = 108) y enfermedad renal crónica (n = 102) que visitaron un hospital de distrito en la provincia de Yogyakarta en Indonesia. Los datos se recopilaron a través de entrevistas y se analizaron utilizando estadísticas descriptivas. Las diferencias significativas en los costos medios entre los diferentes grupos que buscaban servicios de atención médica se determinaron utilizando la prueba U de Mann-Whitney.
Resultados: Los costos totales de bolsillo estimados por paciente en un período de tres meses fueron de IDR 3.411.662 (USD 227,4), IDR 632.665 (USD 42,2) e IDR 3.227.951 (USD 215,2) para accidente cerebrovascular, enfermedad cardíaca y enfermedad renal crónica, respectivamente. Los costos de bolsillo para las tres enfermedades representaron entre el 9 y el 49% de los salarios mínimos regionales. Los costos indirectos fueron los que más contribuyeron al costo total de bolsillo (33-64%), seguidos de los costos médicos directos (12-57%) y los costos no médicos directos (5-33%). Los pacientes que buscaron tratamiento adicional en otros centros de atención médica tendieron a tener costos significativamente más altos.
Conclusiones: Este estudio mostró que las enfermedades crónicas suponen una carga económica relativamente alta para los pacientes. Además, la búsqueda de más centros de atención médica tiende a aumentar los costos.
Palabras Clave: carga económica; costo de bolsillo; costo de la enfermedad;.enfermedad catastrófica.
Citation Format: Endarti D, Andayani TM, Widayanti AW, Rohmah S, Banjarani RR, Ghearizky NA (2025) Chronic disease costs from a patient’s perspective: A survey of patients with stroke, heart disease, and chronic kidney disease visiting a district hospital in Indonesia. J Pharm Pharmacogn Res 13(1): 274–283. https://doi.org/10.56499/jppres24.2036_13.1.274
References
Adeniji F (2021) Burden of out-of-pocket payments among patients with cardiovascular disease in public and private hospitals in Ibadan, Southwest, Nigeria: a cross-sectional study. BMJ Open 11(6): e044044. https://doi.org/10.1136/bmjopen-2020-044044
BPJS (2020) BPJS Kesehatan. INFO BPJS Edisi 104. BPJS Kesehatan, pp. 6–9.
Chatterjee S, Riewpaiboon A, Piyauthakit P, Riewpaiboon W, Boupaijit K, Panpuwong N, Archavanuntagul V (2011) Cost of diabetes and its complications in Thailand: A complete picture of economic burden. Health Soc Care Community 19(3): 289–298. https://doi.org/10.1111/j.1365-2524.2010.00981.x
Endarti D, Widayanti AW, Rahmawati EA, Khaher N, Rahayu S (2020) Cost of illness of type 2 diabetes mellitus from the patient’s perspective: a study from several primary healthcare centres and a hospital in Yogyakarta, Indonesia. Int J Res Pharm Sci 11(4): 7442–7453. https://doi.org/10.26452/ijrps.v11i4.3934
Endarti D, Widayanti AW, Wandansari G, Noventi S (2021) Cost of illness of hypertension from the perspective of patients using a patient-based survey in several primary healthcare centers and a hospital in Yogyakarta, Indonesia. Int J Pharm Res 13(1): 3252–3261. https://doi.org/10.31838/ijpr/2021.13.01.477
Hustrini NM, Susalit E, Rotmans JI (2022) Prevalence and risk factors for chronic kidney disease in Indonesia: An analysis of the National Basic Health Survey 2018. J Glob Health 12: 04074. https://doi.org/10.7189/jogh.12.04074
Jo C (2014) Cost-of-illness studies: concepts, scopes, and methods. Clin Mol Hepatol 20(4): 327–364. https://doi.org/10.3350/cmh.2014.20.4.327
Kosasih DM, Adam S, Uchida M, Yamazaki C, Koyama H, Hamazaki K (2022) Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia. BMC Public Health 22(1): 952. https://doi.org/10.1186/s12889-022-13142-8
Kusuma YS, Babu BV (2019) The costs of seeking healthcare: Illness, treatment seeking and out of pocket expenditures among the urban poor in Delhi, India. Health Soc Care Community 27(6): 1401–1420. https://doi.org/10.1111/hsc.12792
Ma Z, Deng G, Meng Z, Wu H (2021) Hospitalization expenditures and out-of-pocket expenses in patients with stroke in Northeast China, 2015–2017: a pooled cross-sectional study. Front Pharmacol 11: 596183. https://doi.org/10.3389/fphar.2020.596183
Ministry of Health of Republic Indonesia (2013) Buku Pegangan Sosialisasi Jaminan Kesehatan Nasioanl (JKN) Dalam Sistem Jaminan Sosial Nasional.
Musinguzi G, Anthierens S, Nuwaha F, Van Geertruyden JP, Wanyenze RK, Bastiaens H (2018) Factors influencing compliance and health seeking behaviour for hypertension in Mukono and Buikwe in Uganda: A qualitative study. Int J Hypertens 26: 8307591. https://doi.org/10.1155/2018/8307591
Neumann PJ, Sanders GD, Russell LB, Siegel JE, Ganiats TG (2016) Cost-effectiveness in health and medicine. New York: Oxford University Press. https://doi.org/10.1093/acprof:oso/9780190492939.001.0001
Patcharanarumol W, Siengsounthone L, Vonglokham M, Jacobs B, Tangcharoensathien V (2012) Household costs associated with health care seeking at three tertiary care hospitals in Lao PDR. Southeast Asian J Trop Med Public Health 43(6): 1521–1536. https://pubmed.ncbi.nlm.nih.gov/23413717/
Pourhoseingholi MA, Vahedi M, Rahimzadeh M (2013) Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench 6(1): 14–17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017493/
Saramago P, Manca A, Sutton AJ (2012) Deriving input parameters for cost-effectiveness modeling: taxonomy of data types and approaches to their statistical synthesis. Value Health 15(5): 639–649. https://doi.org/10.1016/j.jval.2012.02.009
Sibbritt D, Hosseini M, Peng W, Bayes J, Adams J (2022) The health care utilisation and out-of-pocket expenditure associated with Australian stroke survivors aged 55 and over. PloS One 17(3): e0265907. https://doi.org/10.1371/journal.pone.0265907
Tang CH, Chen HH, Wu MJ, Hsu BG, Tsai JC, Kuo CC, Lin SP, Chen TH, Sue YM (2019) Out-of-pocket costs and productivity losses in haemodialysis and peritoneal dialysis from a patient interview survey in Taiwan. BMJ Open 9(3): e023062. https://doi.org/10.1136/bmjopen-2018-023062
Uli RE, Satyana RP, Zomer E, Magliano D, Liew D, Ademi Z (2020) Health and productivity burden of coronary heart disease in the working Indonesian population using life-table modelling. BMJ Open 10(9): e039221. https://doi.org/10.1136/bmjopen-2020-039221
Valsa Jose J, Susan George J, Joseph R, Arun Thomas ET, Philip John G (2022) Out‐of‐pocket expenditures, catastrophic household finances, and quality of life among hemodialysis patients in Kerala, India. Hemodial Int 26(4): 569-574. https://doi.org/10.1111/hdi.13037
Wang Q, Brenner S, Leppert G, Banda TH, Kalmus O, De Allegri M (2015) Health seeking behaviour and the related household out-of-pocket expenditure for chronic non-communicable diseases in rural Malawi. HPP 30(2): 242–252. https://doi.org/10.1093/heapol/czu004
Wang SY, Valero‐Elizondo J, Ali HJ, Pandey A, Cainzos‐Achirica M, Krumholz HM, Nasir K, Khera R (2021) Out‐of‐pocket annual health expenditures and financial toxicity from healthcare costs in patients with heart failure in the United States. J Am Heart Assoc 10(14): e022164. https://doi.org/10.1161/JAHA.121.022164
Widyasari V, Rahman FF, Ningrum V (2022) The incidence and prevalence of stroke by cause in Indonesia based on Global Burden of Disease Study 2019. In 3rd International Conference on Cardiovascular Diseases (ICCvD 2021), pp. 435–446. Atlantis Press. https://doi.org/10.2991/978-94-6463-048-0_50
WHO (2021) World Health Organization. Non-Communicable Diseases. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases [Consulted 2.13.22].
WHO (2019) World Health Organization. Out-of-pocket payments, user fees and catastrophic expenditure. https://www.who.int/health_financing/topics/financial-protection/out-of-pocket-payments/en/ [Consulted 2.13.22].
© 2025 Journal of Pharmacy & Pharmacognosy Research