Background: Rheumatic heart disease (RHD) is most prevalent in socially disadvantaged settings, placing a severe burden on patients and their households. The study aims to investigate the disparity of healthcare costs, including financial and time costs, among RHD patients in Uganda. Methods: We enrolled 54 RHD households from the Uganda National RHD Registry between June 2019 and February 2021. The patients were interviewed in baseline and 12-month follow-up surveys. A random-effect model was applied to examine the disparity of RHD financial and time costs. Our primary outcomes are the total outpatient costs for RHD patients? most recent visit, consisting of direct medical costs, direct non-medical costs, and time costs. Results: Following the COVID-19 pandemic, the total financial cost of outpatient visits for RHD patients increased by 9 USD on average (P<0.01), with the change primarily driven by non-medical costs such as transportation and food (5.8 USD, P<0.05). Direct medical costs also increased significantly in the pandemic, with an average increase of 3.2 USD (P<0.1). Compared with their counterparts, non-medical costs were higher for patients with poor infrastructure, with less education, who were older, and who were male. Patients with employment experienced a higher time cost than those without (3.3 hours, P<0.01). Conclusions: The COVID-19 pandemic significantly increased RHD outpatient costs, mainly caused by the increase in non-medical costs. Our study implies that improving infrastructure, investing in education, and providing employees with time to seek care have the potential to reduce non-medical barriers to RHD secondary prevention.

The authors have declared no competing interest.

This study was approved by the Makerere University School of Medical Research and Ethics Committee (REC RF 2018-082), the Uganda National Council for Science and Technology (SS 5081), and the University of Washington Department of Human Subjects Division (STUDY00002855). Participants provided written informed consent to participate in the study or, in the case of minors, the informed consent of their legal guardian or next of kin.

This study was supported by the American Heart Association (17SFRN33670611, 17SFRN33630027).

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This study was approved by the Makerere University School of Medical Research and Ethics Committee (REC RF 2018-082), the Uganda National Council for Science and Technology (SS 5081), and the University of Washington Department of Human Subjects Division (STUDY00002855). Participants provided written informed consent to participate in the study or, in the case of minors, the informed consent of their legal guardian or next of kin.

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The raw data supporting the conclusions of this article is available upon request to the authors, without undue reservation. Supplementary file 1: Supplementary Tables. Table S1: Household Characteristics and Demographics. Table S2: Economic and Time Costs of Outpatient Visits. Table S3: Random Effects Model Estimation Results.