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Muniyandi M. Families affected by catastrophic costs due to tuberculosis. Lancet Glob Health 2023; 11:e1492-e1493. [PMID: 37734785 DOI: 10.1016/s2214-109x(23)00422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Malaisamy Muniyandi
- ICMR-National Institute for Research in Tuberculosis, Chennai 600031, India.
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Chatterjee S, Das P, Shikhule A, Munje R, Vassall A. Journey of the tuberculosis patients in India from onset of symptom till one-year post-treatment. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001564. [PMID: 36811090 PMCID: PMC7614204 DOI: 10.1371/journal.pgph.0001564] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 01/14/2023] [Indexed: 02/12/2023]
Abstract
Historically, economic studies on tuberculosis estimated out-of-pocket expenses related to tuberculosis treatment and catastrophic cost, however, no study has yet been conducted to understand the post-treatment economic conditions of the tuberculosis patients in India. In this paper, we add to this body of knowledge by examining the experiences of the tuberculosis patients from the onset of symptoms till one-year post-treatment. 829 adult drug-susceptible tuberculosis patients from general population and from two high risk groups: urban slum dwellers and tea garden families were interviewed during February 2019 to February 2021 at their intensive and continuation phases of treatment and about one-year post-treatment using adapted World Health Organization tuberculosis patient cost survey instrument. Interviews covered socio-economic conditions, employment status, income, out-of-pocket expenses and time spent for outpatient visits, hospitalization, drug-pick up, medical follow-ups, additional food, coping strategies, treatment outcome, identification of post-treatment symptoms and treatment for post-treatment sequalae/recurrent cases. All costs were calculated in 2020 Indian rupee (INR) and converted into US dollar (US$) (1 US$ = INR 74.132). Total cost of tuberculosis treatment since the onset of symptom till one-year post-treatment ranged from US$359 (Standard Deviation (SD) 744) to US$413 (SD 500) of which 32%-44% of costs incurred in pre-treatment phase and 7% in post-treatment phase. 29%-43% study participants reported having outstanding loan with average amount ranged from US $103 to US$261 during the post-treatment period. 20%-28% participants borrowed during post-treatment period and 7%-16% sold/mortgaged personal belongings. Therefore, economic impact of tuberculosis persists way beyond treatment completion. Major reasons of continued hardship were costs associated with initial tuberculosis treatment, unemployment, and reduced income. Therefore, policy priorities to reduce treatment cost and to protect patients from the economic consequences of the disease by ensuring job security, additional food support, better management of direct benefit transfer and improving coverage through medical insurances need consideration.
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Affiliation(s)
- Susmita Chatterjee
- Research Department, George Institute for Global Health, New Delhi, India
- Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Palash Das
- Research Department, George Institute for Global Health, New Delhi, India
| | - Aaron Shikhule
- Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Radha Munje
- Department of Respiratory Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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3
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Kanmani S, Logaraj M, John R, Arumai MM. Is economic burden still a problem among the patients with tuberculosis - A cost analysis: A descriptive cross-sectional study in Tamil Nadu. Indian J Tuberc 2022; 69:602-607. [PMID: 36460396 DOI: 10.1016/j.ijtb.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/17/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND There were more than 10 million people infected with TB across the globe. India has the world's largest tuberculosis load, with 2.4 million recorded cases in 2019. Poverty has an inseparable relationship with Tuberculosis. It is an inevitable risk factor, often resulting in delays in seeking treatment, imposing a financial burden on families, and poor compliance with treatment, etc., thereby leading to a very low rate of success in TB treatment. In this context, a study was undertaken among TB patients in Kanchipuram district with the objective of assessing the different costs associated with treatment and other associated issues they face from society as a consequence of the disease. MATERIALS METHODS A descriptive cross sectional descriptive study design was espoused to study among the 312 TB patients registered in the government's RNTCP program. A multi-stage random sampling technique was adopted to recruit and obtain data from them. A Univariate and bivariate analysis were employed to get the mean costs incurred during the pre & post diagnosis TB treatment. A linear regression test was performed to identify the relationship between the variables that influence the economic burden during the treatment process. CONCLUSION The study demonstrates that the total costs sustained by patients during the post-diagnosis phase are astronomical in contrast to the costs spent during the pre-diagnosis phase. The indirect cost in terms of time lost due to hospital visits and medication pickup, as well as inability to work, imposes a significant economic burden on patients and their families.
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Affiliation(s)
- Sellamuthu Kanmani
- Department of Community Medicine, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology Campus, SRM Nagar, Kattankulathur, Chengalpattu District, Tamil Nadu, 603203, India
| | - Muthunarayanan Logaraj
- Department of Community Medicine, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology Campus, SRM Nagar, Kattankulathur, Chengalpattu District, Tamil Nadu, 603203, India.
| | - Russelselvan John
- Department of Community Medicine, Apollo Institute of Medical Science & Research, Murakambattu, Chittoor, Andhra Pradesh, India
| | - Mariaselvam Mathew Arumai
- Department of Community Medicine, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology Campus, SRM Nagar, Kattankulathur, Chengalpattu District, Tamil Nadu, 603203, India
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Calnan M, Moran A, Jassim AlMossawi H. Maintaining essential tuberculosis services during the COVID-19 pandemic, Philippines. Bull World Health Organ 2022; 100:127-134. [PMID: 35125537 PMCID: PMC8795840 DOI: 10.2471/blt.21.286807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To describe the implementation, use and cost of a phone-based tuberculosis case finding and case management intervention during the coronavirus disease 2019 (COVID-19) pandemic in two regions in the Philippines. Methods We implemented this phone-based intervention to maintain tuberculosis treatment support, active case finding and contact investigation efforts in 42 facilities, starting in June 2020. We established a dedicated mobile phone number for each centre and promoted the intervention on different media platforms. We recruited and trained staff members and provided them with tools for screening and patient follow-up. We collected data on tuberculosis screening, diagnosis and treatment initiation for this intervention and three comparator interventions over the same period. We collected data on number and type of calls placed and received. We estimated the additional cost of this intervention compared to the standard of care. Findings From October 2020 to September 2021, 14 tuberculosis contact centres, for which complete data were available, identified 43.5% (827/1901) of patients with bacteriologically confirmed tuberculosis enrolled in treatment among all comparator interventions. These centres managed 6187 calls over the same period. The additional cost of implementing and running the centre for 12 months was 398 United States dollars per facility. Conclusion The tuberculosis contact centre is a low-technology telehealth intervention which contributed to overall treatment initiation during the COVID-19 pandemic. Additional work should assess the extent to which the contact centre identifies tuberculosis patients previously missed by the health system, regardless of the pandemic.
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Affiliation(s)
- Marianne Calnan
- University Research Co., USAID TB Platforms for Sustainable Detection, Care and Treatment Project, Manila, Philippines
| | - Alexander Moran
- University Research Co., 5404 Wisconsin Ave, Suite 800, Chevy Chase, MD 20815, United States of America
| | - Hala Jassim AlMossawi
- University Research Co., 5404 Wisconsin Ave, Suite 800, Chevy Chase, MD 20815, United States of America
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Ghazy RM, El Saeh HM, Abdulaziz S, Hammouda EA, Elzorkany AM, Khidr H, Zarif N, Elrewany E, Abd ElHafeez S. A systematic review and meta-analysis of the catastrophic costs incurred by tuberculosis patients. Sci Rep 2022; 12:558. [PMID: 35017604 PMCID: PMC8752613 DOI: 10.1038/s41598-021-04345-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 12/13/2021] [Indexed: 12/20/2022] Open
Abstract
One of the strategies of the World Health Organization End Tuberculosis (TB) was to reduce the catastrophic costs incurred by TB-affected families to 0% by 2020.Catastrophic cost is defined by the total cost related to TB management exceeding 20% of the annual pre-TB household income. This study aimed to estimate the pooled proportion of TB affected households who incurred catastrophic costs. We searched PubMed, SciELO, Scopus, Embase, Google Scholar, ProQuest, SAGE, and Web of Science databases according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines till November 20, 2020. Eligible studies were identified and data on catastrophic costs due to TB were extracted. We performed a meta-analysis to generate the pooled proportion of patients with TB facing catastrophic costs. From 5114 studies identified, 29 articles were included in the final analysis. The pooled proportion of patients faced catastrophic costs was (43%, 95% CI [34-51]). Meta-regression revealed that country, drug sensitivity, and Human immune-deficiency Virus (HIV) co-infection were the main predictors of such costs. Catastrophic costs incurred by drug sensitive, drug resistant, and HIV co-infection were 32%, 81%, and 81%, respectively. The catastrophic costs incurred were lower among active than passive case findings (12% vs. 30%). Half (50%) of TB-affected households faced catastrophic health expenditure at 10% cut-off point. The financial burden of patients seeking TB diagnosis and treatment continues to be a worldwide impediment. Therefore, the End TB approach should rely on socioeconomic support and cost-cutting initiatives.PROSPERO registration: CRD42020221283.
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Affiliation(s)
- Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Haider M El Saeh
- Community Medicine Department, Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | | | - Heba Khidr
- Ministry of Health and Population, Alexandria, Egypt
| | - Nardine Zarif
- Ministry of Health and Population, Alexandria, Egypt
| | - Ehab Elrewany
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Samar Abd ElHafeez
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Arinaminpathy N, Nandi A, Vijayan S, Jha N, Nair SA, Kumta S, Dewan P, Rade K, Vadera B, Rao R, Sachdeva KS. Engaging with the private healthcare sector for the control of tuberculosis in India: cost and cost-effectiveness. BMJ Glob Health 2021; 6:bmjgh-2021-006114. [PMID: 34610905 PMCID: PMC8493898 DOI: 10.1136/bmjgh-2021-006114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background The control of tuberculosis (TB) in India is complicated by the presence of a large, disorganised private sector where most patients first seek care. Following pilots in Mumbai and Patna (two major cities in India), an initiative known as the ‘Public–Private Interface Agency’ (PPIA) is now being expanded across the country. We aimed to estimate the cost-effectiveness of scaling up PPIA operations, in line with India’s National Strategic Plan for TB control. Methods Focusing on Mumbai and Patna, we collected cost data from implementing organisations in both cities and combined this data with models of TB transmission dynamics. Estimating the cost per disability adjusted life years (DALY) averted between 2014 (the start of PPIA scale-up) and 2025, we assessed cost-effectiveness using two willingness-to-pay approaches: a WHO-CHOICE threshold based on per-capita economic productivity, and a more stringent threshold incorporating opportunity costs in the health system. Findings A PPIA scaled up to ultimately reach 50% of privately treated TB patients in Mumbai and Patna would cost, respectively, US$228 (95% uncertainty interval (UI): 159 to 320) per DALY averted and US$564 (95% uncertainty interval (UI): 409 to 775) per DALY averted. In Mumbai, the PPIA would be cost-effective relative to all thresholds considered. In Patna, if focusing on adherence support, rather than on improved diagnosis, the PPIA would be cost-effective relative to all thresholds considered. These differences between sites arise from variations in the burden of drug resistance: among the services of a PPIA, improved diagnosis (including rapid tests with genotypic drug sensitivity testing) has greatest value in settings such as Mumbai, with a high burden of drug-resistant TB. Conclusions To accelerate decline in TB incidence, it is critical first to engage effectively with the private sector in India. Mechanisms such as the PPIA offer cost-effective ways of doing so, particularly when tailored to local settings.
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Affiliation(s)
- Nimalan Arinaminpathy
- Department of Infectious Disease Epidemiology, Imperial College London, London, London, UK
| | - Arindam Nandi
- Population Council, New York, New York, USA.,CDDEP, Washington, District of Columbia, USA
| | | | - Nita Jha
- World Health Partners, Patna, India
| | | | - Sameer Kumta
- Bill and Melinda Gates Foundation, India Country Office, New Delhi, India
| | - Puneet Dewan
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Kiran Rade
- World Health Organization Country Office for India, New Delhi, India
| | | | - Raghuram Rao
- National Tuberculosis Elimination Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | - Kuldeep S Sachdeva
- South-East Asia Office, International Union Against Tuberculosis and Lung Disease, New Delhi, India
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7
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Telisinghe L, Ruperez M, Amofa-Sekyi M, Mwenge L, Mainga T, Kumar R, Hassan M, Chaisson L, Naufal F, Shapiro A, Golub J, Miller C, Corbett E, Burke R, MacPherson P, Hayes R, Bond V, Daneshvar C, Klinkenberg E, Ayles H. Does tuberculosis screening improve individual outcomes? A systematic review. EClinicalMedicine 2021; 40:101127. [PMID: 34604724 PMCID: PMC8473670 DOI: 10.1016/j.eclinm.2021.101127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To determine if tuberculosis (TB) screening improves patient outcomes, we conducted two systematic reviews to investigate the effect of TB screening on diagnosis, treatment outcomes, deaths (clinical review assessing 23 outcome indicators); and patient costs (economic review). METHODS Pubmed, EMBASE, Scopus and the Cochrane Library were searched between 1/1/1980-13/4/2020 (clinical review) and 1/1/2010-14/8/2020 (economic review). As studies were heterogeneous, data synthesis was narrative. FINDINGS Clinical review: of 27,270 articles, 18 (n=3 trials) were eligible. Nine involved general populations. Compared to passive case finding (PCF), studies showed lower smear grade (n=2/3) and time to diagnosis (n=2/3); higher pre-treatment losses to follow-up (screened 23% and 29% vs PCF 15% and 14%; n=2/2); and similar treatment success (range 68-81%; n=4) and case fatality (range 3-11%; n=5) in the screened group. Nine reported on risk groups. Compared to PCF, studies showed lower smear positivity among those culture-confirmed (n=3/4) and time to diagnosis (n=2/2); and similar (range 80-90%; n=2/2) treatment success in the screened group. Case fatality was lower in n=2/3 observational studies; both reported on established screening programmes. A neonatal trial and post-hoc analysis of a household contacts trial found screening was associated with lower all-cause mortality. Economic review: From 2841 articles, six observational studies were eligible. Total costs (n=6) and catastrophic cost prevalence (n=4; range screened 9-45% vs PCF 12-61%) was lower among those screened. INTERPRETATION We found very limited patient outcome data. Collecting and reporting this data must be prioritised to inform policy and practice. FUNDING WHO and EDCTP.
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Affiliation(s)
- L Telisinghe
- London School of Hygiene and Tropical Medicine, London, UK
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - M Ruperez
- London School of Hygiene and Tropical Medicine, London, UK
| | - M Amofa-Sekyi
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - L Mwenge
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - T Mainga
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - R Kumar
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - M Hassan
- University Hospitals Plymouth NHS Trust, UK
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Egypt
| | - L.H Chaisson
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, USA
| | - F Naufal
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, USA
| | - A.E Shapiro
- Departments of Global Health and Medicine, University of Washington, Seattle, USA
| | - J.E Golub
- Johns Hopkins University School of Medicine, Center for Tuberculosis Research, Baltimore, USA
| | - C Miller
- Global TB programme, World Health Organization, Geneva, Switzerland
| | - E.L Corbett
- London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - R.M Burke
- London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - P MacPherson
- London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - R.J Hayes
- London School of Hygiene and Tropical Medicine, London, UK
| | - V Bond
- London School of Hygiene and Tropical Medicine, London, UK
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | | | - E Klinkenberg
- London School of Hygiene and Tropical Medicine, London, UK
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - H.M Ayles
- London School of Hygiene and Tropical Medicine, London, UK
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
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Gurung SC, Rai B, Dixit K, Worrall E, Paudel PR, Dhital R, Sah MK, Pandit RN, Aryal TP, Majhi G, Wingfield T, Squire B, Lönnroth K, Levy JW, Viney K, van Rest J, Ramsay A, Santos da Costa RM, Basnyat B, Thapa A, Mishra G, Moreira Pescarini J, Caws M, Teixeira de Siqueira-Filha N. How to reduce household costs for people with tuberculosis: a longitudinal costing survey in Nepal. Health Policy Plan 2021; 36:594-605. [PMID: 33341891 PMCID: PMC8173598 DOI: 10.1093/heapol/czaa156] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to compare costs and socio-economic impact of tuberculosis (TB) for patients diagnosed through active (ACF) and passive case finding (PCF) in Nepal. A longitudinal costing survey was conducted in four districts of Nepal from April 2018 to October 2019. Costs were collected using the WHO TB Patient Costs Survey at three time points: intensive phase of treatment, continuation phase of treatment and at treatment completion. Direct and indirect costs and socio-economic impact (poverty headcount, employment status and coping strategies) were evaluated throughout the treatment. Prevalence of catastrophic costs was estimated using the WHO threshold. Logistic regression and generalized estimating equation were used to evaluate risk of incurring high costs, catastrophic costs and socio-economic impact of TB over time. A total of 111 ACF and 110 PCF patients were included. ACF patients were more likely to have no education (75% vs 57%, P = 0.006) and informal employment (42% vs 24%, P = 0.005) Compared with the PCF group, ACF patients incurred lower costs during the pretreatment period (mean total cost: US$55 vs US$87, P < 0.001) and during the pretreatment plus treatment periods (mean total direct costs: US$72 vs US$101, P < 0.001). Socio-economic impact was severe for both groups throughout the whole treatment, with 32% of households incurring catastrophic costs. Catastrophic costs were associated with 'no education' status [odds ratio = 2.53(95% confidence interval = 1.16-5.50)]. There is a severe and sustained socio-economic impact of TB on affected households in Nepal. The community-based ACF approach mitigated costs and reached the most vulnerable patients. Alongside ACF, social protection policies must be extended to achieve the zero catastrophic costs milestone of the End TB strategy.
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Affiliation(s)
- Suman Chandra Gurung
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Bhola Rai
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
| | - Kritika Dixit
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
- Karolinska Institutet, Department of Global Public Health, 171 77, Stockholm, Sweden
| | - Eve Worrall
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Puskar Raj Paudel
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
- KNCV Tuberculosis Foundation, Maanweg 174, 2516 AB, Den Haag, the The Netherlands
| | - Raghu Dhital
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
| | - Manoj Kumar Sah
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
| | | | | | - Govinda Majhi
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
| | - Tom Wingfield
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Karolinska Institutet, Department of Global Public Health, 171 77, Stockholm, Sweden
| | - Bertie Squire
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Knut Lönnroth
- Karolinska Institutet, Department of Global Public Health, 171 77, Stockholm, Sweden
| | - Jens W Levy
- KNCV Tuberculosis Foundation, Maanweg 174, 2516 AB, Den Haag, the The Netherlands
| | - Kerri Viney
- Karolinska Institutet, Department of Global Public Health, 171 77, Stockholm, Sweden
- Australian National University, Research School of Population Health, College of Health & Medicine, Canberra, ACT 2600, Australia
| | - Job van Rest
- KNCV Tuberculosis Foundation, Maanweg 174, 2516 AB, Den Haag, the The Netherlands
| | - Andrew Ramsay
- University of St Andrews, College Gate St Andrews, KY16 9AJ, UK
| | - Rafaely Marcia Santos da Costa
- Oswaldo Cruz Foundation, Centro de Pesquisa Aggeu Magalhaes, Av. Professor Moraes Rego, s/n – Cidade Universitária – Recife/PE, CEP 50.740-465, Brazil
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, P. O. Box 26500, Kathmandu, Nepal
| | - Anil Thapa
- National Tuberculosis Control Centre, Thimi, Bhaktapur, Nepal
| | - Gokul Mishra
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Julia Moreira Pescarini
- Oswaldo Cruz Foundation, Centro de Integracao de Dados e Conhecimentos para Saude, Rua Mundo, 121, Trobogy, Salvador - Bahia, CEP 41745-715, Brazil
| | - Maxine Caws
- Birat Nepal Medical Trust: Lazimpat, Ward No. 2, Kathmandu, Nepal
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Noemia Teixeira de Siqueira-Filha
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- University of York, Department of Helarh Sciences, Heslington, YO10 5DD, York, UK
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9
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Ghazy RM, Saeh HME, Abdulaziz S, Hammouda EA, Elzorkany A, Kheder H, Zarif N, Elrewany E, Elhafeez SA. A Systematic Review and Meta-Analysis on Catastrophic Cost incurred by Tuberculosis Patients and their Households.. [DOI: 10.1101/2021.02.27.21252453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
AbstractBackgroundAs one of the World Health Organization (WHO) End Tuberculosis (TB) Strategy is to reduce the proportion of TB affected families that face catastrophic costs to 0% by 2020. This systematic review and meta-analysis aimed to estimate the pooled proportion of TB affected households who face catastrophic cost.MethodA search of the online database through September 2020 was performed. A total of 5114 articles were found, of which 29 articles got included in quantitative synthesis. Catastrophic cost is defined if total cost related to TB exceeded 20% of annual pre-TB household income. R software was used to estimate the pooled proportion at 95% confidence intervals (CIs) using the fixed/random-effect models.ResultThe proportion of patients faced catastrophic cost was 43% (95% CI 34-52, I2= 99%); 32% (95% CI 29 – 35, I2= 70%) among drug sensitive, and 80% (95% CI 74-85, I2= 54%) among drug resistant, and 81% (95%CI 78-84%, I2= 0%) among HIV patients. Regarding active versus passive case finding the pooled proportion of catastrophic cost was 12% (95% CI 9-16, I2= 95%) versus 42% (95% CI 35-50, I2= 94%). The pooled proportion of direct cost to the total cost was 45% (95% CI 39-51, I2= 91%). The pooled proportion of patients facing catastrophic health expenditure (CHE) at cut of point of 10% of their yearly income was 45% (95% CI 35-56, I2= 93%) while at 40% of their capacity to pay was 63% (95% CI 40-80, I2= 96%).ConclusionDespite the ongoing efforts, there is a significant proportion of patients facing catastrophic cost, which represent a main obstacle against TB control.PROSPERO registrationCRD42020221283
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Chandra A, Kumar R, Kant S, Krishnan A. Diagnostic Pathways and Delays in Initiation of Treatment among Newly Diagnosed Tuberculosis Patients in Ballabgarh, India. Am J Trop Med Hyg 2021; 104:1321-1325. [PMID: 33617478 DOI: 10.4269/ajtmh.20-1297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/05/2021] [Indexed: 11/07/2022] Open
Abstract
A delay in diagnosis and initiation of treatment in patients with tuberculosis (TB) can affect the period of communicability and cost of treatment. We aimed to describe the diagnostic pathways and delays in initiation of treatment among drug-sensitive newly diagnosed TB patients in Ballabgarh, India. In May 2019, we interviewed 110 TB patients who were put on treatment in the past 2 months. It was a cross-sectional study where data collection was conducted by a physician. We used a structured questionnaire to collect the information on care-seeking practices, delays, and patient's cost. Descriptive analysis was carried out for the pathways, delays, and patient cost. The mean number of health facility contacted before the diagnosis of TB was 2.8 (SD: 1.3); 76% of patients first sought care at a private health facility. The median total delay was 34.5 (IQR: 21-60) days; median patient delay seven (IQR: 2-21) days, median health system delay 16 (IQR: 8-45) days, median diagnostic delay 32.5 (IQR: 18-57) days, and median treatment delay two (IQR: 1-3) days. Health system delay was 2.2 times longer than patient delay; the health system delay was primarily due to delay in diagnosis. Patients contacting private health facility first had 1.7 times total delay, 2.4 times longer health system delay, and 3.4 times of direct cost compared with patients contacting a public health facility first. Accelerated efforts are needed to achieve India's target to eliminate TB by 2025.
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Cilloni L, Kranzer K, Stagg HR, Arinaminpathy N. Trade-offs between cost and accuracy in active case finding for tuberculosis: A dynamic modelling analysis. PLoS Med 2020; 17:e1003456. [PMID: 33264288 PMCID: PMC7710036 DOI: 10.1371/journal.pmed.1003456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Active case finding (ACF) may be valuable in tuberculosis (TB) control, but questions remain about its optimum implementation in different settings. For example, smear microscopy misses up to half of TB cases, yet is cheap and detects the most infectious TB cases. What, then, is the incremental value of using more sensitive and specific, yet more costly, tests such as Xpert MTB/RIF in ACF in a high-burden setting? METHODS AND FINDINGS We constructed a dynamic transmission model of TB, calibrated to be consistent with an urban slum population in India. We applied this model to compare the potential cost and impact of 2 hypothetical approaches following initial symptom screening: (i) 'moderate accuracy' testing employing a microscopy-like test (i.e., lower cost but also lower accuracy) for bacteriological confirmation and (ii) 'high accuracy' testing employing an Xpert-like test (higher cost but also higher accuracy, while also detecting rifampicin resistance). Results suggest that ACF using a moderate-accuracy test could in fact cost more overall than using a high-accuracy test. Under an illustrative budget of US$20 million in a slum population of 2 million, high-accuracy testing would avert 1.14 (95% credible interval 0.75-1.99, with p = 0.28) cases relative to each case averted by moderate-accuracy testing. Test specificity is a key driver: High-accuracy testing would be significantly more impactful at the 5% significance level, as long as the high-accuracy test has specificity at least 3 percentage points greater than the moderate-accuracy test. Additional factors promoting the impact of high-accuracy testing are that (i) its ability to detect rifampicin resistance can lead to long-term cost savings in second-line treatment and (ii) its higher sensitivity contributes to the overall cases averted by ACF. Amongst the limitations of this study, our cost model has a narrow focus on the commodity costs of testing and treatment; our estimates should not be taken as indicative of the overall cost of ACF. There remains uncertainty about the true specificity of tests such as smear and Xpert-like tests in ACF, relating to the accuracy of the reference standard under such conditions. CONCLUSIONS Our results suggest that cheaper diagnostics do not necessarily translate to less costly ACF, as any savings from the test cost can be strongly outweighed by factors including false-positive TB treatment, reduced sensitivity, and foregone savings in second-line treatment. In resource-limited settings, it is therefore important to take all of these factors into account when designing cost-effective strategies for ACF.
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Affiliation(s)
- Lucia Cilloni
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- * E-mail:
| | - Katharina Kranzer
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Research Centre Borstel, Sülfeld, Germany
| | - Helen R. Stagg
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Nimalan Arinaminpathy
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
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Rupani MP, Cattamanchi A, Shete PB, Vollmer WM, Basu S, Dave JD. Costs incurred by patients with drug-susceptible pulmonary tuberculosis in semi-urban and rural settings of Western India. Infect Dis Poverty 2020; 9:144. [PMID: 33076969 PMCID: PMC7574230 DOI: 10.1186/s40249-020-00760-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022] Open
Abstract
Background India reports the highest number of tuberculosis (TB) cases worldwide. Poverty has a dual impact as it increases the risk of TB and exposes the poor to economic hardship when they develop TB. Our objective was to estimate the costs incurred by patients with drug-susceptible TB in Bhavnagar (western India) using an adapted World Health Organization costing tool. Methods We conducted a descriptive cross-sectional study of adults, notified in the public sector and being treated for drug-susceptible pulmonary TB during January–June 2019, in six urban and three rural blocks of Bhavnagar region, Gujarat state, India. The direct and indirect TB-related costs, as well as patients’ coping strategies, were assessed for the overall care of TB till treatment completion. Catastrophic costs were defined as total costs > 20% of annual household income (excluding any amount received from cash transfer programs or borrowed). Median and interquartile range (IQR) was used to summarize patient costs. The median costs between any two groups were compared using the median test. The association between any two categorical variables was tested by the Pearson chi-squared test. All costs were described in US dollars (USD). During the study period, on average, one USD equalled 70 Indian Rupees. Results Of 458 patients included, 70% were male, 62% had no formal education, 71% lived in urban areas, and 96% completed TB treatment. The median (IQR) total costs were USD 8 (5–28), direct medical costs were USD 0 (0–0), direct non-medical costs were USD 3 (2–4) and indirect costs were USD 6 (3–13). Among direct non-medical costs, travel cost (median = USD 3, IQR: 2–4) to attend health facilities were the most prominent, whereas the indirect costs were mainly contributed by the patient’s loss of wages (median = USD 3, IQR: 0–6). Four percent of patients faced catastrophic costs, 11% borrowed money to cover costs and 7% lost their employment; the median working days lost to TB was 30 (IQR: 15–45). A majority (88%) of patients received a median USD 43 (IQR: 41–43) as part of a cash transfer program for TB patients. Conclusions Treatment completion was high and the costs incurred by TB patients were low in this setting. However, negative financial consequences occur even in low-cost settings. The role of universal cash transfer programs in such settings requires further study.
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Affiliation(s)
- Mihir P Rupani
- Department of Community Medicine, Government Medical College Bhavnagar (Maharaja Krishnakumarsinhji Bhavnagar University), Near ST Bus Stand, Jail Road, Bhavnagar, Gujarat 364001, India.
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco (UCSF), California, USA
| | - Priya B Shete
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco (UCSF), California, USA
| | - William M Vollmer
- Division of Biostatistics, Kaiser Permanente Center for Health Research, Portland, USA
| | - Sanjib Basu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, USA
| | - Jigna D Dave
- Department of Respiratory Medicine, Government Medical College Bhavnagar (Maharaja Krishnakumarsinhji Bhavnagar University), Bhavnagar, Gujarat, India
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Thakur G, Thakur S, Thakur H. Status and challenges for tuberculosis control in India - Stakeholders' perspective. Indian J Tuberc 2020; 68:334-339. [PMID: 34099198 PMCID: PMC7550054 DOI: 10.1016/j.ijtb.2020.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tuberculosis is one of the ten major causes of mortality worldwide. The trend of increasing TB cases and drug resistance in India is very disturbing. The objectives of the study were to study the perspectives and opinions of different stakeholders on the status, challenges and the ways to tackle the issues of TB in India. METHODS The online survey was done for the data collection from national and international experts. The data collection took place during October 2017. We received 46 responses. RESULTS The experts had varied answers as to the menace of TB in India, effect of TB on individuals, family and society, failure of government plans in India, TB awareness campaign and ways to create awareness. Everyone believed that urgent action needs to be taken against the disease like improving the healthcare infrastructure of the country (improving the quality and quantity of medical facilities and doctors) and creating awareness about the TB. CONCLUSION Government of India is making lot of efforts to bring down the problems associated with TB through. In spite of this, there is a long way to go to achieve significant reduction in high incidence and prevalence of TB in India. Factors like lack of awareness and resources, poor infrastructure, increasing drug resistant cases, poor notification and overall negligence are the major challenges. If we eradicate poverty and undernourishment, educate the masses and eliminate the stigma attached with TB, we can hope for a disease free future.
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Affiliation(s)
| | - Shalvi Thakur
- Indian Institute of Science, Education and Research, Bhopal, India
| | - Harshad Thakur
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India; National Institute of Health and Family Welfare, New Delhi, India.
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Sinha P, Carwile M, Bhargava A, Cintron C, Acuna-Villaorduna C, Lakshminarayan S, Liu AF, Kulatilaka N, Locks L, Hochberg NS. How much do Indians pay for tuberculosis treatment? A cost analysis. Public Health Action 2020; 10:110-117. [PMID: 33134125 DOI: 10.5588/pha.20.0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/25/2020] [Indexed: 11/10/2022] Open
Abstract
Setting India's National Tuberculosis Elimination Programme (NTEP) covers diagnostic and therapeutic costs of TB treatment. However, persons living with TB (PLWTB) continue to experience financial distress due to direct costs (payment for testing, treatment, travel, hospitalization, and nutritional supplements) and indirect costs (lost wages, loan interest, and cost of domestic helpers). Objective To analyze the magnitude and pattern of TB-related costs from the perspective of Indian PLWTB. Design We identified relevant articles using key search terms ('tuberculosis,' 'India,' 'cost,' 'expenditures,' 'financing,' 'catastrophic' and 'out of pocket') and calculated variance-weighted mean costs. Results Indian patients incur substantial direct costs (mean: US$46.8). Mean indirect costs (US$666.6) constitute 93.4% of the net costs. Mean direct costs before diagnosis can be up to four-fold that of costs during treatment. Treatment in the private sector can result in costs up to six-fold higher than in government facilities. As many as one in three PLWTB in India experience catastrophic costs. Conclusion PLWTB in India face high direct and indirect costs. Priority interventions to realize India's goal of eliminating catastrophic costs from TB include decreasing diagnostic delays through active case finding, reducing the need for travel, improving awareness and perception of NTEP services, and ensuring sufficient reimbursement for inpatient TB care.
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Affiliation(s)
- P Sinha
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA
| | - M Carwile
- Department of Global Health, Boston University School of Public Health, MA, USA
| | - A Bhargava
- Department of Medicine, Yenepoya Medical College, Mangalore, India.,Department of Medicine, McGill University, Montreal, Quebec, Canada.,Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, India
| | - C Cintron
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA
| | - C Acuna-Villaorduna
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA
| | - S Lakshminarayan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - A F Liu
- Department of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA
| | - N Kulatilaka
- Susilo Institute for Ethics in a Global Economy, Boston University Questrom School of Business, Boston, MA, USA
| | - L Locks
- Department of Health Sciences, Sargent College, Boston University College of Health & Rehabilitation Sciences, Boston, MA, USA
| | - N S Hochberg
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA.,Department of Epidemiology, Boston University School of Public Health, MA, USA
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