Out-of-pocket expenditure on non-communicable diseases during Covid-19. A cross-sectional study from a semi-urban area of Kannur, Kerala

INTRODUCTION: Non-communicable disease (NCD) care was drastically affected during the COVID-19 pandemic. Therefore, this study aimed to estimate the cost incurred for NCD care during the pandemic and also to compare the cost of care of private and public facility utilizers. METHODS: This community-based cross-sectional analytical study was conducted among 316 individuals aged 30 years and above from selected primary care facility service areas in Kannur district, Kerala. The total cost of illness for all NCDs was calculated from the patient's perspective and was estimated using a bottom-up approach. Direct, indirect, and total costs were summarized using the median with IQR. A median regression analysis was done to find the factors associated with total cost. RESULTS: The total median direct medical cost was ₹400.0 (120–2360.0), and the total median direct non-medical cost was ₹720.0 (300.0–1200.0). The total median cost of NCD care was ₹1200.0.0 (200.0–3990.0). There was a significant association between the place of NCD service utilization and cost. The cost of availing care from private [₹2497.5 (455.0–6490.0)] was much higher compared to public facilities [₹120.0 (0–1000.0)]. CONCLUSION: The expenditure on NCD care during COVID-19 was high and for a private facility utilizer, it was much higher compared to a government facility utilizer. Strengthening the services through subcentres can reduce travel expenses, hence the non-medical cost of NCD care.