# Catastrophic Health Expenditures and Their Determinants Among Stroke Patients and Their Households: A Study From Semnan, Iran

## TL;DR

This study examines the high healthcare costs faced by stroke patients in Iran and identifies factors contributing to these financial burdens.

## Contribution

The study provides new insights into the determinants of catastrophic health expenditures specifically among stroke patients in Semnan, Iran.

## Key findings

- 67% of stroke patients in Semnan face catastrophic health expenditures.
- Direct medical costs account for 1.30 times household non-food expenses.
- Age, insurance coverage, and disease complications significantly influence CHE.

## Abstract

Stroke sufferers may be exposed to unmanageable medical costs because of the severe complications that can arise from the condition and the impairment of their economic capacity.

This study investigates the prevalence and underlying factors of catastrophic health expenditure (CHE) among stroke patients in Semnan, Iran.

The present cross‐sectional study was conducted in 2024 with the participation of 270 patients. The study tool was a researcher‐designed questionnaire based on patients' clinical records. The content validity of the questionnaire was subsequently confirmed by experts, obtaining scores of 0.96 and 0.94 for the CVR and CVI indices, respectively. The incidence of CHE was calculated using the model of “allocating at least 40% of household non‐food expenses for health care.” The statistical relationship between demographic and background variables and the occurrence of CHE was assessed using logistic regression.

Stroke patients annually pay an average of 339,580,000 IRR (915.86 USD) for necessary care, with 5% allocated to diagnostic services, 12% to physician visits, and 83% to treatment care. The ratio of direct medical costs to non‐food expenses was estimated at 1.30 ( ± 2.30), and 67% of patients face CHE. In the regression analyses, variables such as age (OR: 1.572), supplemental insurance coverage (OR: 2.501), and the occurrence of disease complications such as facial paralysis (OR: 0.253), limb paralysis (OR: 0.122), and impaired consciousness (OR: 0.228) were identified as influencing factors for CHE (p < 0.05).

The high costs imposed on patients with strokes, especially in terms of medications and hospitalization, have imposed unusual economic pressure on patients and the occurrence of an unusual and unacceptable level of CHE. The study also identified some demographic and background determinants of the occurrence of CHE in patients with stroke, which should be noted in conducting interventions by policymakers.