Out-of-Pocket Expenditure for Yellow Fever Vaccination in Chhattisgarh, India

Background: Yellow fever (YF) vaccination is essential for international travel and prevention of fatal viral disease. Despite a fixed fee in India, out-of-pocket expenditure (OOPE), especially indirect costs, may limit access. Evidence on OOPE remains limited in central India. This study aimed to estimate OOPE and associated factors. Materials and Methods: A hospital-based cross-sectional study was conducted at the Immunization Clinic of tertiary care centre of Raipur. A total of 141 beneficiaries aged ≥18 years were enrolled consecutively. Data were collected through face-to-face interviews using a structured questionnaire capturing socio-demographic, vaccination-related, OOPE information. Data were analysed using non-parametric tests, and generalized linear model with Gamma distribution. Results: Average OOPE was ₹9,841.77 ± 15,607.08 (~US$102.85 ± 163.09). Mean direct medical, direct non-medical, and indirect costs were ₹413.90 (~US$4.33), ₹3,534.25 (~US$36.93), and ₹5,893.62 (~US$61.59), respectively. Univariate analysis showed higher OOPE was significantly associated with several sociodemographic and travel-related factors. In the adjusted regression model, current employment, residence outside Chhattisgarh and multiple mode of transportation were significantly associated with higher OOPE (p <0.001). Conclusions: OOPE for yellow fever vaccination is substantial and largely driven by indirect costs, highlighting the need to improve accessibility and reduce financial barriers to ensure equitable uptake.