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Xia L, Gao L, Zhong Y, Wu Y, He J, Zou F, Jian R, Xia S, Chen C, Zhu S. Assessing the influencing factors of out-of-pocket costs on tuberculosis in Sichuan Province: a cross-sectional study. BMC Public Health 2023; 23:1391. [PMID: 37468877 DOI: 10.1186/s12889-023-16180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/22/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Although diagnosis and treatment services for tuberculosis (TB) are provided free of charge in most countries, direct non-medical and indirect costs due to absenteeism, also place a significant burden on patients and their families. Sichuan Province has the second highest incidence of TB in China, with an incidence of approximately 100 cases per 100 000 people. However, there are limited research on out-of-pocket expenditure (OOPE) and its influencing factors in TB patients in Sichuan Province. METHODS A retrospective cross-sectional study was conducted on TB patients in designated medical institutions for TB in Sichuan Province from 2017-2021. A face-to-face questionnaire was conducted to obtain the information related to hospitalization of patients, and the multi-level regression model was used to analyse the factors that influence OOPE and total out-of-pocket expenditure (TOOPE) of TB patients. RESULTS A total of 2644 patients were investigated, and 74.24% of TB patients and their families experienced catastrophic total costs due to TB. The median total cost was 9223.37 CNY (1429.98 USD), in which the median direct and indirect costs of TB patients were 10185.00 CNY (1579.07 USD) and 2400.00 CNY (372.09 USD), respectively, and indirect costs contributed to 43% of total costs. The median OOPE and TOOPE costs were 6024.00 CNY (933.95 USD) and 11890.50 CNY (1843.49 USD), respectively. OOPE and TOOPE had common influencing factors including whether the patient's family had four or more members, a history of hospitalization, combination with other types of TB, the number of visits before diagnosis, and co-occurrence with chronic disease. CONCLUSIONS The OOPE and TOOPE for TB patients and their families in Sichuan Province are still heavy. In the long run, it is necessary to strengthen education and awareness campaigns on TB related knowledge, disseminate basic medical knowledge to the public, improve healthcare-seeking behavior, and enhance the healthcare infrastructure to improve the accuracy of TB diagnosis and reduce the significant OOPE and TOOPE faced by TB patients and their families in Sichuan Province.
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Affiliation(s)
- Lan Xia
- Department of Tuberculosis, Sichuan Provincial Center for Disease Control and Prevention, No.6 Middle School Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Lijie Gao
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Yin Zhong
- Department of Tuberculosis, Sichuan Provincial Center for Disease Control and Prevention, No.6 Middle School Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Ya Wu
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Jinge He
- Department of Tuberculosis, Sichuan Provincial Center for Disease Control and Prevention, No.6 Middle School Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Fengjuan Zou
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Ronghua Jian
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Sujian Xia
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Chuang Chen
- Department of Tuberculosis, Sichuan Provincial Center for Disease Control and Prevention, No.6 Middle School Road, Wuhou District, Chengdu, 610041, Sichuan Province, China.
| | - Sui Zhu
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China.
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Iskandar D, Suryanegara FDA, van Boven JFM, Postma MJ. Clinical pharmacy services for tuberculosis management: a systematic review. Front Pharmacol 2023; 14:1186905. [PMID: 37484021 PMCID: PMC10360183 DOI: 10.3389/fphar.2023.1186905] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
Objective: This study aims to systematically review the content and potential effects of clinical pharmacy services in tuberculosis (TB) care management. Methods: Searches were performed in PubMed, Embase, Cochrane, Scopus, and Web of Science databases following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Study characteristics and outcomes were extracted, and clinical pharmacy service components were characterized using the Descriptive Elements of Pharmacist Intervention Characterization Tool. Results: Twenty articles were included for full-text assessment, of which 10 fulfilled inclusion criteria, comprising 1,168 patients (N = 39 to 258 per study). These articles included five prospective cohort studies, two case-control studies, two quasi-experimental studies, and one cross-sectional study. Intervention foci within clinical pharmacy services were medication adherence (50%), medication safety (40%), education to patients/caregivers regarding needs/beliefs (30%), optimizing medication/therapy effectiveness (30%), emphasizing HRQoL (10%), and drug selections (10%). The three most frequently applied interventions were drug information/patient counseling (80%), adverse drug reaction monitoring (50%), and drug use evaluation (20%). Based on the World Health Organization (WHO) outcome classification, treatment success ranged from 72% to 93%, with higher cure outcomes (53%-86%) than treatment completion (7%-19%). Other outcomes, including isoniazid metabolites, medication counts, sputum conversion, adherence/compliance, knowledge, and quality of life, were better in the intervention group than those in comparator groups, and/or they improved over time. Risk of bias analysis indicated that the included studies were not comparable to a randomized clinical trial. Conclusion: Clinical pharmacy services as single or composite interventions potentially improve TB outcomes, but its evidence is still inconsistent and limited due to the lack of randomized controlled studies using the WHO outcome classification. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=199028, identifier CRD42020199028.
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Affiliation(s)
- D. Iskandar
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Faculty of Pharmacy, Bhakti Kencana University, Bandung, Indonesia
| | - F. D. A. Suryanegara
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - J. F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - M. J. Postma
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Economics, Econometrics, and Finance, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
- Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
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Razzaq S, Zahidie A, Fatmi Z. Estimating the pre- and post-diagnosis costs of tuberculosis for adults in Pakistan: household economic impact and costs mitigating strategies. Glob Health Res Policy 2022; 7:22. [PMID: 35858877 PMCID: PMC9301862 DOI: 10.1186/s41256-022-00259-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite free tuberculosis (TB) care in Pakistan, patients still have to bear high costs, which push them into poverty. This study estimated the pre- and post-diagnosis costs households bear for TB care, and investigated coping mechanisms among adults ≥ 18 years in Karachi, Pakistan. METHODS We conducted a cross-sectional study comprising of 516 TB patients identified with completion of at least one month intensive treatment from four public sector health facilities from two institutes in Karachi, Pakistan. A standardized questionnaire to estimate patient's costs was administered. The study outcomes were direct medical and non-medical costs, and indirect costs. The costs were estimated during pre-diagnostic and post-diagnostic phase which includes diagnostic, treatment, and hospitalization phases. A descriptive analysis including mean and standard deviation (± SD), median and interquartile range (IQR), and frequencies and proportions (%) was employed. RESULTS Out of 516 TB patients, 52.1% were female with a mean age of 32.4 (± 13.7) years. The median costs per patient during the pre-diagnostic, diagnostic, treatment and hospitalization periods were estimated at USD63.8/ PKR7,377, USD24/ PKR2,755, USD10.5/ PKR1,217, and USD349.0/ PKR40,300, respectively. The total household median cost was estimated at USD129.2/ PKR14,919 per patient. The median indirect cost was estimated at USD52.0/ PKR5,950 per patient. Of total, 54.1% of patients preferred and consulted private providers in the first place at the onset of symptoms, while, 36% attended public healthcare services, 5% and 4.1% went to dispensary and pharmacy, respectively, as a first point of care. CONCLUSIONS TB patients bear substantial out-of-pocket costs before they are enrolled in publically funded TB programs. There should be provision of transport and food vouchers, also health insurance for in-patient treatment. This advocates a critical investigation into an existing financial support network for TB patients in Pakistan towards reducing the burden.
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Affiliation(s)
- Shama Razzaq
- Health Services Academy, Opposite National Institute of Health (NIH), Islamabad, Pakistan
| | - Aysha Zahidie
- Aga Khan University, Community Health Sciences Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Zafar Fatmi
- Aga Khan University, Community Health Sciences Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
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Hubens K, Krol M, Coast J, Drummond MF, Brouwer WBF, Uyl-de Groot CA, Hakkaart-van Roijen L. Measurement Instruments of Productivity Loss of Paid and Unpaid Work: A Systematic Review and Assessment of Suitability for Health Economic Evaluations From a Societal Perspective. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1686-1699. [PMID: 34711370 DOI: 10.1016/j.jval.2021.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 05/16/2023]
Abstract
OBJECTIVES This study aimed (1) to perform a systematic literature review of instruments for measuring productivity loss of paid and unpaid work and (2) to assess the suitability (in terms of identification, measurement, and valuation) of these instruments for use in health economic evaluations from a societal perspective. METHODS Articles published from 2018 were sourced from PubMed/Medline, PsycInfo, Embase, and Econlit. Using 2 separate search strategies, eligible economic evaluations and validation studies were selected and unique measurement instruments identified. A data-extraction form was developed by studying previous literature and consulting an international panel of experts in the field of productivity costs. This data-extraction form was applied to assess the suitability of instruments for use in economic evaluations. RESULTS A total of 5982 articles were retrieved from the databases, of which 99 economic evaluations and 9 validation studies were included in the review. A total of 42 unique measurement instruments were identified. Nine instruments provided quantified measures of absenteeism, presenteeism, and unpaid work. Five instruments supplied the necessary information to enable the use of at least 1 common valuation method. The Health and Labour Questionnaire-Short Form, Health and Labour Questionnaire, and Institute for Medical Technology Assessment Productivity Cost Questionnaire met both criteria. Nevertheless, the developers replaced the Health and Labour Questionnaire-Short Form and Health and Labour Questionnaire by the more recently developed Institute for Medical Technology Assessment Productivity Cost Questionnaire. CONCLUSIONS Although many instruments for measuring productivity loss were identified, most were not suitable for capturing productivity changes for economic evaluations from a societal perspective. Future research can benefit from this study by making an informed instrument choice for the measurement of productivity loss of paid and unpaid work.
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Affiliation(s)
- Kimberley Hubens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
| | | | - Joanna Coast
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | | | - Werner B F Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Queiroz DC, Turi BC, Sarti FM, Dos Santos Ferro I, de Morais LC, Sanches Codogno J. Association between quality of life, physical activity, use of medication and costs of treatment for chronic diseases in Primary Care. J Sports Med Phys Fitness 2019; 60:456-463. [PMID: 31684710 DOI: 10.23736/s0022-4707.19.10170-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of this study was to investigate the costs and the health outcomes of primary care treatments for chronic diseases and to analyze the association between domains of quality of life (QoL), physical activity and healthcare costs. METHODS The sample encompassed 292 patients aged 50 years or more in Brazilian primary care facilities, categorized in three groups: no drug treatment or only regular physical activity, only drug treatment, and drug treatment with regular physical activity. Patients were assessed in relation to quality of life, healthcare costs, regular physical activity, and use of medications. RESULTS Results indicate higher cost-utility ratio among primary care patients adopting only drug treatment (3.92), followed by drug treatment with regular physical activity (3.21), and no drug treatment or only regular physical activity (0.12). CONCLUSIONS QoL was significantly associated with risk factors for chronic diseases, especially obesity, and limitations in mobility showed important increases in healthcare costs. The dominant strategy in terms of cost-utility ratio was identified among primary care patients without drug treatment or physically active, followed by patients in drug treatment combined with regular physical activity. Drug treatment without regular physical activity showed worst results in relation to other primary care strategies.
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Affiliation(s)
- Dayane C Queiroz
- São Paulo State University, Campus of Presidente Prudente, Presidente Prudente, Brazil -
| | - Bruna C Turi
- São Paulo State University, Campus of Presidente Prudente, Presidente Prudente, Brazil
| | | | | | - Luana C de Morais
- São Paulo State University, Campus of Presidente Prudente, Presidente Prudente, Brazil
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