Cost of illness of non-communicable diseases in private and public health facilities in Nigeria: a qualitative and quantitative approach

Introduction: the cost of illness (COI) of non -communicable diseases (NCDs) has detrimental effects on healthcare outcomes in addition to the serious economic impact on patients and their families. This study estimated and compared the COI of NCDs and its predictors in private and public health facilities (HF) in Ado-Ekiti, Nigeria. Methods: the study was carried out in selected HF (39 private; 11 public) using a comparative cross-sectional design with a mixed method of data collection. Quantitative data were collected from 348 hypertensive and/or diabetic patients (173 private; 175 public) using a semi-structured, interviewer -administered questionnaire while qualitative data were from 5 key informant interviews (KII) conducted with HF heads or their representatives. Results: the average monthly COI of NCDs was higher among patients in private (N15,750.38 +/- 14,286.47 [US$43.75 +/- 39.68]) than in public HF (N13,283.37 +/- 16,432.68 [US$ 36.90 +/- 45.65]) (P<0.001), however, the indirect cost was higher in public HF (private, N1,561.07 [US$4.34]; public, N3,739.26 [US$10.39]) (p<0.001). Predictors of COI of NCDs identified were income and admission in both groups. Additionally, age, payment method, type of NCDs, having two or more complications, and exercise were identified in private while socioeconomic status, length of diagnosis, and alcohol were identified in public HF. The KII revealed a long waiting time for the public HF patients which accounted for the huge indirect cost. Conclusion: the study found a huge indirect cost in the public HF that could be minimized by developing policies that would reduce the waiting time of patients. Government and private interventions targeting identified predictors should be applied to reduce the financial burden of NCD.