Black fungus treatment after Covid-19 costs patients ₹10-12 lakh
Even as the district health department directed private hospitals to set up day-care facilities to make treatments affordable for mucormycosis (black fungus) patients, many are spending about ₹10-12 lakh at private super-speciality hospitals in the absence of government facilities.
Doctors concurred that the treatment cost is high as multiple vials of the main drug used in the treatment, Liposomal Amphotericin B — a 50mg vial of which costs ₹6,000 — have to be administered daily for at least two weeks.
“A patient has to take four to six vials, every day, based on the body weight, for at least two weeks,” said Dr Dhirendra Singh Kushwah, consultant, ENT, Narayana super speciality hospital in Sector 24.
Patients said that besides spending over ₹3 lakh solely on the drug, they have to shell out ₹5-7 lakh for other medicines and the hospital charges for two weeks.
Currently, at least 180 cases are under treatment in the district, according to the district health department data.
To reduce the treatment cost, on May 10, the district health department directed private hospitals to set up a day-care facility for administering the Amphotericin B drug, which requires nearly four hours for infusion along with constant monitoring of vitals. The price of the facility has been capped at ₹2,000 per day for National Accreditation Board for Hospitals and healthcare providers (NABH) and at ₹1,500 at non-NABH facilities.
Dr Rahul Bhargava, principal director, Hematology, Fortis Memorial Research Institute in Gurugram, said, “Infusion of Amphotericin-B along with other fluids and potassium takes at least six hours, which used to cost roughly about ₹8,000. Following the line of treatment where a patient will need to visit the hospital for four weeks, the overall cost of the facility adds up to ₹2,40,000. Therefore, by capping the price, the cost drastically comes down to ₹60,000.”
According to him, expenditure on the treatment of one black fungus case is equivalent to treating at least 10-15 Covid-19 patients.
Hira Singh, 44, a resident of Rewari district, who took underwent nose surgery at a private hospital on May 18 after getting infected with black fungus has spent almost ₹12 lakh on treatment.
His nephew Dr Hitesh Yadav, an intern at the Post Graduate Institute of Medical Sciences – Rohtak, said that the family has spent almost ₹7 lakh on the amphotericin drug alone and ₹5 lakh on the surgery.
“For almost 25 days, my uncle is on Amphotericin-B drug, which has to be arranged from outside. For a single vial, we had to pay about ₹8,000 to ₹10,000. Surgery, which is important in line with the treatment, cost around ₹5 lakh. Other hospital expenditures added to the overall cost. Later, he was shifted to home where he has been under medical care and getting the Amphotericin-B drug. The treatment of black fungus is highly expensive,” said Yadav.
Black fungus has been found mostly among people with uncontrolled diabetes, whose immunity is compromised, or among people who are given excessive steroids or immunity-modulating drugs such as tocilizumab. According to doctors, if left untreated, it could kill up to 80% of those infected. If not detected early, it affects the orbit of the eye and the mouth, resulting in people losing their vision or jaw during debridement, the process of removing dead tissue from an infection or wound.
Dr Bhargava said, “Since it can directly impact kidneys, fluid has to be given to the patient. Also, the potassium level in the blood declines. In nearly 10% of cases, it leads to potassium abnormalities which can lead to heart problems. Considering all these factors, a day-care facility is required to help patients who do not require hospitalisation.”
According to Kushwah, patients are generally admitted for three to four days after the surgery where dead tissues are removed from the infected region. “Patients who have been discharged have to regularly visit the hospital for administration of the Amphotericin-B drug. For this, a few beds are reserved in the emergency ward as an infusion of the drug takes over four hours, with constant monitoring of kidney functions and potassium level in the body,” said Kushwah.
In the district, at least 292 cases of back fungus have been reported by private hospitals, of which 134 are from Gurugram and the remaining from other states and districts. Currently, 180 patients are under treatment, while 28 have succumbed to the illness. Data provided by the district health department shows that at least 197 cases are diabetic. According to doctors, until last month, at least three cases were admitted every day. With the decline in the cases, it has reduced to almost three patients a week.
Dr Ravinder Gera, director and head of department, ENT and neck surgery, Max Hospital, said that the ideal situation would be to admit patients to the hospital for two weeks till the time Amphotericin-B drug is required to be administered. “It is critical to monitor the impact of the drug after infusion. Potassium levels generally reduce after eight to 10 hours of the drug administration, making constant monitoring of patients crucial,” said Gera.
“If the drug is given for at least seven days, then the cost comes around ₹40,000 to ₹60,000. Only after considering the vitals, a patient is shifted to oral medicines. Even oral medicines cost about ₹3,000 a day, which is also expensive,” said Gera.
According to Gera, 22 cases were reported at the hospital, of which seven are currently admitted, two have succumbed to the illness, while the remaining are undertaking daily visits.
Dr Jai Prakash, district surveillance officer for Covid-19, said, “In case a patient approaches a government hospital, they are referred to the medical college in Nuh or Rohtak, where the treatment is free.”