What is the cost of diagnosis, treatment for pulmonary diseases


In the fourth part of this series on major illnesses in India, ET Wealth tells you the cost of diagnosis and treatment for pulmonary diseases, so that you can ensure adequate insurance and financial readiness.

What are pulmonary diseases?

Any disease that affects lungs and parts of the respiratory system is known as pulmonary disease. Brought into the limelight by Covid, also a respiratory disorder, these diseases are mostly caused by bacterial, viral or fungal infections, smoking tobacco, environmental factors like pollution, and occupational hazards like fumes, dust and chemicals.

According to the World Health Organisation (WHO), chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, resulting in 3.23 million deaths in 2019. In India, it is the second leading cause of death and disability adjusted life years (DALYs) among non-infectious diseases, with 32% of the total global DALYs occurring in India, according to the Global Burden of Disease (GBD) report.

Types of pulmonary/lung diseases

“Respiratory diseases are mostly chronic in nature and the most prevalent in India are asthma, COPD, interstitial lung disease (ILD), allergy and pulmonary tuberculosis,” says Dr Sharad Joshi, Associate Director & Head of Department, Pulmonology, Max Superspecialty Hospital, Vaishali. “Other than simple allergies, pneumonia and viral infections, most lung diseases last a lifetime and patients have to be on medication all through their lives,” he adds.

COSTS

We shall consider the doctor’s consultation fee, disagnostic and treatment costs for the three most prevalent lung diseases: asthma, COPD and ILD. “Since respiratory patients will have variations in symptoms all year long because of various factors like temperature change, pollution, dust or viral illnesses, the cost of treatment will vary. It will include OPD treatment throughout the year till they live, and intermittently, hospitalisation cost,” says Dr Joshi.

Doctor’s consultation fee

  • Pulmonologist: Rs.500-3,000

Diagnostic tests

For asthma, COPD and ILD, the diagnostic tests will vary and we shall consider each of these separately.

ASTHMA: It can be caused by allergies, environmental factors, respiratory infections or due to genetics. The symptoms include cough, breathlessness, chest tightness and wheezing, and the diagnostic tests are as follows:

Spirometry or Pulmonary Function Test (PFT) with reversibility: This test will help show whether the patient has reversible airway changes consistent with asthma or not.

Allergic profile: If the patient has severe asthma and requires more than two inhalers or more than three drugs, tests are conducted to evaluate what kind of allergies the patient has. It is done either through blood test or prick test.

Blood test: It’s a simple blood test to

identify allergies.

Phadiatop test: It is an advanced serological test for screening allergic sensitisation in patients.

Prick test: This requires 150 pricks on the forehead to test for allergens (allergy-causing substances) and observing for signs of an allergic reaction.

Chronic Obstructive

Pulmonary Disease:

This also requires a variety of tests to arrive at an accurate diagnosis. Spirometry or Pulmonary Function Test (PFT): This is the most common and effective test to assess lung functioning and capacity.

Chest X-ray or CT Scan: This provides a visual image of lungs to check for enlarged lungs, air pockets or fl at diaphragm.

  • Cost (X-ray): Rs.250-500
  • Cost (CT Scan): Rs.5,000

Arterial blood gas analysis: This blood test gauges how much oxygen is in your blood, and hence, how well the lungs are functioning.

Interstitial Lung

Disease: This is a disease where the cartilage layer surrounding the lungs thickens and inhibits the absorption of oxygen in lungs. “ILD is an umbrella term since various other diseases can cause this and diagnostic costs are very high as it includes various tests,” says Dr Joshi.

High-resolution CT Scan: This is the foremost test that is conducted and is also required annually after the treatment begins.

Blood test: If it is connective tissuelinked ILD, an auto-immune profi le of the patient is required, which is conducted through a blood test.

HP Panel test: If it is hypersensitivity pneumonitis-linked ILD, it responds well to treatment and in 5-10% cases, the patient can recover. To test it, an HP panel test is needed, which is not easily available in labs across the country.

Spirometry or Pulmonary Function Test

(PFT): To check the lung functionality, PFT will be required.

Lung diffusion test: This is a part of PFT.

6-minute walk test: Also called oxygen desaturation test, it is also a part of PFT.

Treatment costs

The treatment costs vary signifi cantly according to the type and stage of the lung or respiratory disease.

ASTHMA

Course of treatment: Asthma can have several triggers, including infections like cold and fl u, weather changes, allergies, medicines, stress, etc. The best treatment is inhalers and 50% of the patients will be stable with these, but the rest will require other medication, including steroids, which will add to the cost. “The steroids themselves don’t cost much, but the hidden cost is very heavy due to their side-effects,” says Dr Joshi.

Doctor’s visits: This will usually be 3-4 times a year

Inhalers: These are available in three forms: Dry powder inhalers (dpi)

Pressurised metered dose inhalers (mpi)

Nebulisers: The machine itself is expensive and then there is the medicine to be put in it.

  • Cost of machine:Rs.2,000-3,000
  • Cost of medicine: Rs.1,500 per month

Steroids: These are cheaper, but the side-effects will require heavier medication, which is considered the hidden cost.

  • Cost:Rs.100-200 per month
  • Hidden cost:Rs.500-700 per month

Flu shot: These are administered once a year.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Course of treatment: “COPD is a nonreversible disease and will require medication and treatment for one’s entire life,” says Dr Joshi. “It is an old person’s disease and is usually found in patients who are above 40 years of age. They have multiple co-morbidities and symptom control is poor with inhalers, require more frequent OPD visits and hospitalisation,” says Dr Joshi. There are four listed stages of COPD.

Stage A is mild, with symptoms under control, very low exacerbations (worsening or fl aring up of normal COPD symptoms) and not requiring hospitalisation. Stage B is one where exacerbations are higher but don’t require hospitalisation.

  • Costs for Stages A & B
  • Doctor’s visits: Once a month.
  • Cost:Rs.1,500 per visit

Inhalers: These patients require two or more inhalers.

Steroids: These may be occasionally needed for patients.

  • Cost:Rs.100-200 per month
  • Hidden cost:Rs.500-700 per month

Pneumococcal vaccine: These are advised to all respiratory patients and administered about once in fi ve years

Stage C is one where symptoms can be controlled but still require frequent hospitalisation.

Stage D is one where the patient has lost most of lung function, frequently exacerbates, and requires very frequent hospitalisation.

  • Costs for Stages C & D
  • Doctor’s visits: Once a month.
  • Cost:Rs.1,500 per visit

Hospitalisation: For patients left with only 15-20% of lung function, it can be almost every month.

  • Cost:Rs.1-1.5 lakh (4-5 days).

Inhalers: These patients require two or more inhalers.

  • Cost:Rs.5,000-6,000 a month.

Steroids: These may be occasionally needed for patients.

  • Cost:Rs.100-200 per month
  • Hidden cost:Rs.500-700 per month

Pneumococcal vaccine: These are administered once in five years.

Oxygen machine: After being discharged from hospital, the patient may need oxygen support at home.

BiPAP machine: This is required for respiratory support.

INTERSTITIAL LUNG DISEASE

Course of treatment: This is the most deadly disease where patients require an anti-fi brotic treatment. This calls for immuno-suppressant drugs, which have high side-effects and are expensive. Immuno-suppressants:

Inhalers:

  • Cost:Rs.5,000-6,000 a month
  • Medication (anti-oxidants, calcium, etc):
  • Cost:Rs.4,500 a month

Oxygen machine: “30% of ILD patients will need oxygen at home, and 100% will need it during the later stages,” says Dr Joshi.

Lung transplant: Even after a successful transplant, life expectancy is only about two years.

Ventilator: If patients of ILD, COPD and asthma are in severe respiratory failure, they will need to be put on a ventilator, which can last 3-30 days.



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