Renju M Alex, John V Peter, Anna Paul, Tina George, Bijesh Yadav, Muruga B Kalimuthu, Anand Zachariah, Sowmya Sathyendra, Samuel G Hansdak, Ramya Iyyadurai, Kishore K Pichamuthu, Binila Chacko, Thambu D Sudarsanam
Critical illness imposes substantial financial burden on families. Caregivers were WTP more for sicker patients with lower utility scores. Subsidy for treatment was required despite caregivers' final payment exceeding their initial WTP.How to cite this article: Alex RM, Peter JV, Paul A, George T, Yadav B, Kalimuthu MB, et al. Willingness and Ability to Pay for Critical Care Treatment for Non-COVID Illness during the COVID-19 Pandemic: A Prospective Observational Study in a Tertiary Care Centre in India. Indian J Crit Care Med 2026;30(8):679-685.
BACKGROUND AND AIMS: The COVID-19 pandemic impacted families financially. In this context, we assessed caregivers' willingness-to-pay (WTP) for the treatment of a critical illness among non-COVID admissions.
PATIENTS AND METHODS: This prospective study was conducted over 1 year in a 38-bed level-3 adult medical intensive care unit (ICU) at a not-for-profit tertiary care teaching hospital in India. Intensive care unit costs were assessed using a bottom-up micro-costing approach. Utility score was evaluated on day 2 by the intensivist on a scale of 0 to 1 with increments of 0.1; 0 indicating death/severe disability and 1 indicating cure/perfect health. Caregivers' WTP was assessed by the admitting physician using the bidding method. Demographic details, Acute Physiology and Chronic Health Evaluation (APACHE) II score, ICU outcome, and costs were recorded. Willingness-to-pay and actual caregiver contribution were expressed as percentages of the total hospitalization cost.
RESULTS: The mean [standard deviation (SD)] age (n = 105, 68 males) was 45.3 (17.2) years. A total of 83.8% belonged to the lower socioeconomic strata. Acute Physiology and Chronic Health Evaluation II score was 15.2 (8.0); day 2 utility score was 0.68 (0.14). The median [interquartile range (IQR)] hospitalization cost was 2,49,767 (1,59,251-4,19,602) rupees. Intensive care unit treatment and medications accounted for 95.5-20.5% of the total cost, respectively. Although caregivers' median WTP was 60.1% of the hospitalization cost, families ultimately paid 67.9%. Lower utility scores were independently associated with higher WTP.
CONCLUSION: Critical illness imposes substantial financial burden on families. Caregivers were WTP more for sicker patients with lower utility scores. Subsidy for treatment was required despite caregivers' final payment exceeding their initial WTP.How to cite this article: Alex RM, Peter JV, Paul A, George T, Yadav B, Kalimuthu MB, et al. Willingness and Ability to Pay for Critical Care Treatment for Non-COVID Illness during the COVID-19 Pandemic: A Prospective Observational Study in a Tertiary Care Centre in India. Indian J Crit Care Med 2026;30(8):679-685.