Assessment of Out of Pocket Expenditure and associated factors for availing COVID-19 vaccination by the beneficiaries in Bengaluru: South India

  1. Sunil Kumar Dodderi
  2. H Lakshmi
  3. J Srividya
  4. S Manjula
  5. R S Swathi

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Abstract

Background

Government of India has introduced COVID 19 vaccination in Jan 2021. There are no studies on out of pocket expenditure in COVID-19 vaccination in India, hence this study was undertaken to estimate the out of pocket expenditure for availing COVID 19 vaccine, to assess the factors associated with out of pocket expenditure for COVID vaccination and adverse events following immunisation.

Methods

This is a cross-sectional study conducted during Sep 2021-Dec 2021 of a medical college. A total of 438 study subjects above 18 years fulfilling inclusion and exclusion criteria were studied using probability proportional to population size. Data was collected using interview method by pre-tested semi structured proforma and analysed using descriptive & inferential statistics.

Results

The mean direct cost in Government vaccination centre was 3.24± 6.74 INR, indirect cost 809.10±1076.35 INR, total cost was 812.34 ±1079.49 INR.The mean direct cost in private vaccination centre was 1446.9±1845.65 INR, indirect cost 1140±1398 INR and total cost was 2586.90±2241.54 INR.

The mean total cost was OOPE for COVID 19 vaccination was 852.80 ±1128.512 INR, out of which direct cost was only 36.17(±359.20). The higher mean OOPE was found in loss of wages 670.02 INR. The factors associated with higher out of pocket expenditure was type of vaccine (P=0.031, OR=2.141, 95% CI=1.07-4.24) occupation of the study subject (P=0.000, OR=2.043, 95% CI= 1.37-3.03), reported stress following vaccination (P= 0.018, OR=1.72, 95%CI=1.098-2.703), adverse event within 48hrs (P=0.006, OR=2.125, 95% CI= 1.248-3.62), received any medication for adverse event (P=0.041, OR= 1.721, 95% CI= 1.022-2.84)

Conclusion

Majority of the study subjects utilized public facility. The higher mean out of pocket expenditure was for indirect cost loss of wages. This study shows that type of vaccine, occupation of the study subject and adverse event within 48 hrs, had 2 times higher out of pocket expenditure compared to other factors. Among the AEFI, fever was the most common, followed by pain at the injection site and myalgia.

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  1. ScreenIT

    SciScore for 10.1101/2022.01.29.22270032: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Ethical Clearance was obtained from Institutional ethical committee, Akash Institute of Medical Sciences and Research Centre, Bengaluru, India.
    Consent: Respondents fully vaccinated for more than 15 days, who gave informed consent and resided for more than 6 months were enrolled.
    Sex as a biological variablenot detected.
    RandomizationIn each area, an approximate centre was marked, one of the roads was selected randomly by lottery method.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The data collected was entered in MS excel and computed using SPSS 25.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitation of the study could be the recall bias of the study participants. With less than a third of health expenditure covered by the government, the major burden of India’s health costs falls on individual households, per the National Health Account Estimates. Household out-of-pocket expenditure on health made up for 58.7% of the total health expenditure, One in five Indians fall below the poverty line and more are pushed into poverty every year due to health expenses, according to World Bank data. The central government’s expanded Covid-19 vaccination procurement policy also allows private hospitals to purchase doses directly from manufacturers, and to set prices for consumers. Currently, both SII and Bharat Biotech are providing doses to private hospitals at higher rates than to state governments. SII set the rate of Covishield for private hospitals at Rs 600 per dose and Bharat Biotech set the rate at Rs 1,200. Given this policy, manufacturers have a financial incentive to divert more stocks towards private hospitals. The entire course of two doses for people getting vaccinated in private facilities is a minimum Rs 1,200-Rs 2,400, just for the doses. Private hospitals also add charges for administering the vaccines. These rates are unaffordable for a large section of the Indian population. The monthly per capita income of an average four-member household was Rs 4,979 in October 2020, seven months after the Covid-19 nationwide lockdown was imposed – a 17% decrease from t...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2022.01.29.22270032 on medRxiv