Cost calculations in health care

Sir,

Apropos of the article on demographics of animal bite victims published recently, the authors have done an admirable job to study the demographics of animal bite victims and management practices in a tertiary care institute in Mumbai, Maharashtra, India. The authors have found that the patients visited the hospital from 2-6 times after the bite and that the median cost to the patient per bite was 220/-. Economic burden from the patient's perspective was calculated using both direct and indirect costs1.

Without questioning the methodology of the study, I have a few queries which seem to be inadequately addressed in the article. For a general reader, it would have been easier to interpret if the details on cost were explained.

The indirect costs need to be calculated considering the occupation and the time of the bite. For instance, if the patient is a government employee, then indirect costs incurred to him or her by an animal bite will be less as compared to a daily wager, as the daily wager will lose his income for the day for taking the day off to visit a health facility to get vaccinated, whereas the patient who is in service can take a casual leave for the same thereby saving a day's income. The indirect costs may also vary on account of the distance one has to travel to reach the health facility and the mode of transport being used (personal or private).

It would have been beneficial if the authors had calculated the indirect costs individually for each of the participants in terms of the loss of daily wages (if any), the distance they had to travel to the health facility and their expenditure done including the extra parallel expenses for the day out. Further, the authors have mentioned that 783 of the 1000 consecutive patients who presented to the institution had category III bite. There may have been some patients in need to get admitted for the same. The days spent in the hospital (if applicable) needs to be considered as it further adds to the economic burden on the patient in terms of DALYs (disability adjusted life years) and the other additional inpatient costs.