AB1142 TREATMENT COSTS OF SELECTED RHEUMATIC DISEASES IN SUB-SAHARAN AFRICA: A CASE FOR IMPROVED INSURANCE COVERAGE FOR AFRICAN PATIENTS
Authors: A. Akpabio, C. Nga, I. Umoh, O. Ita
Journal: Annals of the Rheumatic Diseases (2020)

Background: Rheumatic diseases lead to substantial economic costs 1 especially in resource-poor settings like sub-Saharan Africa (SSA). 2 Annual direct cost of lupus treatment ranges from $13,735-20,926 /patient in the US to £3231($4232)/patient in the UK. 1,3 Data is rare for SSA and Nigeria in particular where the minimum wage is N30,000 ($83/mth) with only 5% of citizens covered by health insurance. 4,5 The scheme excludes some medications and certain procedures are grossly underfunded. Cost-of-illness studies are invaluable in planning and policy development. They typically include: direct, indirect and intangible costs. 6 Objectives: To compare total costs of some rheumatic diseases, highlight underfunded therapies and push for wider insurance coverage of rheumatic diseases. Methods: A cross-sectional study from the University of Uyo Teaching Hospital - Nigeria using data of 252 clinic patients (20 lupus, 27 rheumatoid arthritis, 25 gout and 180 osteoarthritis). Direct costs were estimated using the hospital pricelist while indirect costs were estimated using the human capital method. Statistical analysis was done with p&lt;0.05. Results: Females were the majority except for gout patients (44%). Most lupus patients were unemployed (75%) and had the highest annual total cost (N472,800–2,240,400) compared with the others. Key medications excluded from insurance are shown in table 2. Table 2. Uninsured treatments. MMF Methotrexate Sulphasalazine Azathioprine HCQ Febuxostat Colchicine Rituximab Arthroplasty (N100,000*) Dialysis (6 sessions) Renal transplant TABLE 1. COST-OF-ILLNESS COMPARISON OF SELECTED RHEUMATIC DISEASES Lupus (n=20) RA(n=27) Gout(n=25) OA(n=180) Age (years) 33.9 ± 11.4 43.4 ± 14.3 57.4 ± 9.6 59.7 ± 9.1 Female n (%) 24(95) 25(92) 11(44) 157(87) Average Duration of illness (years) 4(1-11) 3.5(2-10) 3 (0.2-8) 4(0.1-20) Unemployed n (%) 15(75.0) 19(70.3) 12(48.0) 62(34.4) Workdays missed/mth 7 5 2 3 Direct costs (N’000) Total /mth (stable) 32.4 27 19.75 18 Total /yr (stable) 388.8 324 237 216 Total /mth (severe) 179.7 155.6 32.5 23 Total /yr (severe) 2,156.4 1,867.2 390 276 Indirect costs Productivity loss/mth 7 5 2 3 Productivity loss/yr 84 60 24 36 Total costs/mth Total costs/yr 39.4 – 186.7 472.8 – 2,240.4 32 – 160.6 384 – 1.927.2 21.75 – 34.5 261 – 414 21 – 26 252 – 312 1$ = 360 Nigerian Naira (NGN), 1€ = NGN 402 as at 31/1/2020. Costs quoted in thousands of Naira. Conclusion: Total annual cost of lupus treatment in Nigeria is quite high ranging from (NGN 472,800–2,242,400) [$1313- 6228] for mild to severe disease. This contrasts with a mean annual national income of $1,000 given that 75% of lupus patients are unemployed. Expanded insurance coverage for rheumatic drugs will further reduce the enormous treatment burden and improve outcomes. References: [1]Slawsky KS et al. A structured literature review of the direct costs of Adult SLE in the US. Arthritis Care Res 2011:63(9); 1224-32. [2]Adelowo OO. Connective tissue diseases: challenges of management among Nigerians. Annals of Health Research. 2016: 2(2);60-65. [3]Khamashta M et al. The cost of care of SLE in the UK: Annual direct costs for adult SLE patients with active autoantibody disease. Lupus 2013:23(3):273-83 [4]Uzochukwu BSC et al. Health care financing in Nigeria: Implications for achieving universal health coverage. Nigerian Journal of Clinical Practice. 2015;18(4):437-44. [5]Nigerian National Minimum Wage. https://tradingeconomics.com/nigeria/minimum-wages Accessed (31/01/2020). [6]Zhu TY et al. Cost of illness studies in systemic lupus erythematosus: a systematic review. Arthritis Care Res. 63: 751-760 Acknowledgments: All study participants, Drs Marvelous Ibanga and Eke Ogudu. Disclosure of Interests: None declared