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Sweeney S, Fielding K, Liu X, Thompson JA, Dong H, Jiang S, Zhao Y, Huan S, Vassall A. Unit costs and cost-effectiveness of a device to improve TB treatment adherence in China. IJTLD OPEN 2024; 1:299-305. [PMID: 39035432 PMCID: PMC11257087 DOI: 10.5588/ijtldopen.23.0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 05/27/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Adherence to TB drugs is crucial for improving treatment outcomes. Digital adherence technologies can improve adherence; however, there is a lack of evidence on cost-effectiveness. This study aimed to explore the cost-effectiveness of medication event reminder monitors (MERM) in China compared with the standard of care, using results from a pragmatic, cluster-randomised superiority trial of an electronic MERM in China. METHODS We collected primary unit cost data from the societal perspective, both at and above the health facility level. We estimated the incremental cost-effectiveness of MERM using a Markov model with a 20-year time horizon; a 3% discount rate was applied to costs and outcomes. We explored uncertainty through a series of sensitivity and scenario analyses. RESULTS The incremental cost of MERM was $27.22 per patient. Probabilistic sensitivity analysis showed significant uncertainty about the intervention's cost-effectiveness. Changing assumptions around key parameters substantially affected our estimated incremental cost-effectiveness ratio. CONCLUSIONS Although the incremental cost of the MERM box was low, current evidence does not indicate that the intervention would be cost-effective. However, the intervention's cost-effectiveness could improve if implemented as part of a broader strategy, including enhanced patient management.
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Affiliation(s)
- S Sweeney
- London School of Hygiene & Tropical Medicine, London, UK
| | - K Fielding
- London School of Hygiene & Tropical Medicine, London, UK
| | - X Liu
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - J A Thompson
- London School of Hygiene & Tropical Medicine, London, UK
| | - H Dong
- PATH China Office, Beijing, China
| | - S Jiang
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Y Zhao
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - S Huan
- Bill & Melinda Gates Foundation China Office, Beijing, China
| | - A Vassall
- London School of Hygiene & Tropical Medicine, London, UK
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Kanwal S, Kumar D, Chauhan R, Raina SK. Measuring the Effect of Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB-PMJAY) on Health Expenditure among Poor Admitted in a Tertiary Care Hospital in the Northern State of India. Indian J Community Med 2024; 49:342-348. [PMID: 38665468 PMCID: PMC11042133 DOI: 10.4103/ijcm.ijcm_713_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/02/2023] [Indexed: 04/28/2024] Open
Abstract
Background Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB-PMJAY) as a financial risk protection scheme intends to reduce catastrophic health expenditure (CHE), especially among poor. The current study was carried out to assess the utility of AB-PMJAY in terms of reduction in CHE from before and after admission in a tertiary hospital in the northern state of India. Methodology It was a hospital-based cross-sectional study carried out from August 2020 to October 2021 at a public tertiary hospital of Himachal Pradesh, India. Data were collected from surgery- and medicine-allied (SA and MA) specialties. Along with socio-demographic details, information for total monthly family expenditure (TMFE), out-of-pocket expenditure (OOPE), and indirect illness-related expenditure (IIE) was recorded before and after hospital admission. CHE was considered as more than 10.0% OOPE of THFE and more than 40.0% of capacity to pay (CTP). Results A total of 336 participants with a mean age of 46 years were recruited (MA: 54.6%). The majority (~93.0%) of participants had illness of fewer than 6 months. The mean TMFE was observed to be INR 4213.1 (standard deviation: 2483.7) and found to be similar across specialties. The OOPE share of TMFE declined from 76.1% (before admission) to 30.0% (after admission). Before admission, CHE was found among 65.5% (10.0% of THFE) and 54.2% (40.0% of CTP) participants. It reduced to about 29.0% (based on both THE and CTP) after admission to hospital. Conclusion AB-PMJAY scheme found to be useful in reducing CHE in a tertiary hospital.
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Affiliation(s)
- Shweta Kanwal
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India
| | - Dinesh Kumar
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India
| | - Raman Chauhan
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India
| | - Sunil Kumar Raina
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India
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3
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de Medeiros RL, Moreira ADSR, Neves ACDOJ, Leite VDJ, de Almeida IN, Mello FCDQ, Kritski A. Analysis of catastrophic costs incurred by patients with multidrug-resistant tuberculosis in an outpatient clinic in the state of Rio de Janeiro. Rev Soc Bras Med Trop 2023; 56:e01482023. [PMID: 37909505 PMCID: PMC10615334 DOI: 10.1590/0037-8682-0148-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is a serious global public health concern associated with social vulnerability. In Brazil, the Unified Health System (SUS, Portuguese) provides free diagnosis and treatment for MDR-TB; however, other expenses may still be incurred for patients and their families which, according to the World Health Organization (WHO), can be catastrophic when these costs surpass 20.0% of the annual household income. This study aimed to assess the extent of catastrophic costs related to the diagnostic and therapeutic aspects of MDR-TB among patients receiving care at an outpatient clinic in Rio de Janeiro. METHODS This prospective study used convenience sampling from July 2019 to June 2021. Data regarding direct and indirect costs were collected using a standardized questionnaire endorsed by the WHO. To analyze any impoverishment occurred from MDR-TB, a threshold established by the Brazilian Institute of Geography and Statistics for 2019 and 2020 of US$ 79,562 and US$ 94,5273, respectively, was applied. Descriptive statistics were used for data analysis, including mean; standard deviation; variation coefficient; median; and maximum, minimum, and interquartile ranges. RESULTS A total of 65 patients were interviewed. Among the participants, 73.8% experienced catastrophic costs, with indirect costs exerting the most significant impact (median: US$ 3,825.9), in contrast to direct costs (median: US$ 542.7). When comparing the periods before and after diagnosis, the prevalence of poverty increased from 12.0% to 28.0%. CONCLUSIONS Despite the support from the SUS in Brazil, diagnostic and therapeutic cascades incur additional costs, exacerbating social vulnerability among patients with MDR-TB.
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Affiliation(s)
- Regielle Luiza de Medeiros
- Universidade Federal do Rio de Janeiro, Programa Acadêmico de Tuberculose, Escola de Medicina, Rio de Janeiro, RJ, Brasil
| | | | | | - Viviane de Jesus Leite
- Universidade Federal do Rio de Janeiro, Programa de Pós-Graduação em Ensino de Matemática, Instituto de Matemática, Rio de Janeiro, RJ, Brasil
| | - Isabela Neves de Almeida
- Universidade Federal de Ouro Preto, Programa de Pós-Graduação em Biotecnologia, Núcleo de Pesquisa em Ciências Biológicas, Ouro Preto, MG, Brasil
| | | | - Afrânio Kritski
- Universidade Federal do Rio de Janeiro, Programa Acadêmico de Tuberculose, Escola de Medicina, Rio de Janeiro, RJ, Brasil
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Wang Y, Huang Z, Chen H, Yuan Y, McNeil EB, Lu X, Zhang A. The Association Between Household Financial Burden and Patient Mobility and Their Impact on Loss to Follow-Up Among Multidrug-Resistant Tuberculosis Patients in Guizhou, China. Risk Manag Healthc Policy 2023; 16:909-919. [PMID: 37220483 PMCID: PMC10200133 DOI: 10.2147/rmhp.s400667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose We aimed to assess the household financial burden due to multidrug-resistant tuberculosis (MDR-TB) treatment and its predictors, examine its association with patient mobility, and test their impact on patient loss to follow-up (LTFU). Methods A cross-sectional study combining follow-up data collection was conducted at the largest designated MDR-TB hospital in Guizhou. Data were collected from medical records and questionnaires. Household financial burden was measured by the incidence of 2 indicators: catastrophic total costs (CTC) and catastrophic health expenditure (CHE). Mobility was classified as mover or non-mover after the patient's address was verified twice. A multivariate logistic regression model was used to identify associations between variables. Model I and Model II were separated by CHE and CTC. Results Out of 180 households, the incidence of CHE and CTC was 51.7% and 80.6%, respectively. Families with low income and patients who were primary income earners were significantly associated with catastrophic costs. 42.8% of patients were movers. Patients from households with CHE (ORadj=2.2, 95% CI: 1.1-4.1) or with CTC (ORadj=2.6, 95% CI: 1.1-6.3) were more likely to move. Finding a job against financial difficulty (58.4%) was the top reason for movers. 20.0% of patients experienced LTFU. Patients from households with catastrophic payments (CHE: ORadj=4.1, 95% CI 1.6-10.5 in Model I; CTC: ORadj=4.8, 95% CI 1.0-22.9 in Model II), patients who were movers (ORadj=6.1, 95% CI 2.5-14.8 in Model I; ORadj=7.4, 95% CI 3.0-18.7 in Model II) and primary income earners (ORadj=2.5, 95% CI: 1.0-5.9 in Model I; ORadj=2.7, 95% CI 1.1-6.6 in Model II) had an increased risk of LTFU. Conclusion There is a significant association between household financial burden due to MDR-TB treatment and patient mobility in Guizhou. They impact patients' treatment adherence and cause LTFU. Being a primary breadwinner increases the risk for catastrophic household payments and LTFU.
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Affiliation(s)
- Yun Wang
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
| | - Zhongfeng Huang
- Department of Tuberculosis, Guiyang Public Health Clinical Center, Guiyang, Guizhou, People’s Republic of China
| | - Huijuan Chen
- Department of Tuberculosis Prevention and Control, Guizhou Center for Disease Prevention and Control, Guiyang, Guizhou, People’s Republic of China
| | - Ye Yuan
- Department of Tuberculosis, Guiyang Public Health Clinical Center, Guiyang, Guizhou, People’s Republic of China
| | - Edward B McNeil
- Department of Infectious Diseases, School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Xiaolong Lu
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
| | - Aihua Zhang
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
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Teo AKJ, Rahevar K, Morishita F, Ang A, Yoshiyama T, Ohkado A, Kawatsu L, Yamada N, Uchimura K, Choi Y, Chen Z, Yi S, Yanagawa M, Oh KH, Viney K, Marais B, Kim H, Kato S, Liu Y, Ong CW, Islam T. Tuberculosis in older adults: case studies from four countries with rapidly ageing populations in the western pacific region. BMC Public Health 2023; 23:370. [PMID: 36810018 PMCID: PMC9942033 DOI: 10.1186/s12889-023-15197-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The Western Pacific Region has one of the fastest-growing populations of older adults (≥ 65 years) globally, among whom tuberculosis (TB) poses a particular concern. This study reports country case studies from China, Japan, the Republic of Korea, and Singapore reflecting on their experiences in managing TB among older adults. FINDINGS Across all four countries, TB case notification and incidence rates were highest among older adults, but clinical and public health guidance focused on this population was limited. Individual country reports illustrated a range of practices and challenges. Passive case finding remains the norm, with limited active case finding (ACF) programs implemented in China, Japan, and the Republic of Korea. Different approaches have been trialled to assist older adults in securing an early diagnosis, as well as adhering to their TB treatment. All countries emphasised the need for person-centred approaches that include the creative application of new technology and tailored incentive programs, as well as reconceptualisation of how we provide treatment support. The use of traditional medicines was found to be culturally entrenched among older adults, with a need for careful consideration of their complementary use. TB infection testing and the provision of TB preventive treatment (TPT) were underutilised with highly variable practice. CONCLUSION Older adults require specific consideration in TB response policies, given the burgeoning aging population and their high TB risk. Policymakers, TB programs and funders must invest in and develop locally contextualised practice guidelines to inform evidence-based TB prevention and care practices for older adults.
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Affiliation(s)
- Alvin Kuo Jing Teo
- grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW Australia
| | - Kalpeshsinh Rahevar
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines.
| | - Fukushi Morishita
- grid.483407.c0000 0001 1088 4864World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Alicia Ang
- grid.508010.cDivision of Infectious Diseases, Department of Medicine, Woodlands Health, Singapore, Singapore
| | - Takashi Yoshiyama
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Akihiro Ohkado
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Lisa Kawatsu
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Norio Yamada
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Kazuhiro Uchimura
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Youngeun Choi
- Korean National Tuberculosis Association, Seoul, Republic of Korea
| | - Zi Chen
- Office of International Cooperation, Innovation Alliance on Tuberculosis Diagnosis and Treatment, Beijing, China
| | - Siyan Yi
- grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore ,grid.513124.00000 0005 0265 4996KHANA Center for Population Health Research, Phnom Penh, Cambodia ,grid.265117.60000 0004 0623 6962Center for Global Health Research, Public Health Program, Touro University California, Vallejo, CA USA
| | - Manami Yanagawa
- grid.483407.c0000 0001 1088 4864World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kyung Hyun Oh
- grid.483407.c0000 0001 1088 4864World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kerri Viney
- grid.3575.40000000121633745Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Ben Marais
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW Australia
| | - Heejin Kim
- Korean National Tuberculosis Association, Seoul, Republic of Korea
| | - Seiya Kato
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Yuhong Liu
- grid.24696.3f0000 0004 0369 153XBeijing Chest Hospital, Capital Medical University, Beijing, China
| | - Catherine W.M. Ong
- grid.412106.00000 0004 0621 9599Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Infectious Diseases Translational Research Programme, Department of Medicine, National University of Singapore, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Tauhid Islam
- grid.483407.c0000 0001 1088 4864World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
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Li H, Chang E, Zheng W, Liu B, Xu J, Gu W, Zhou L, Li J, Liu C, Yu H, Huang W. Multimorbidity and catastrophic health expenditure: Evidence from the China Health and Retirement Longitudinal Study. Front Public Health 2022; 10:1043189. [PMID: 36388267 PMCID: PMC9643627 DOI: 10.3389/fpubh.2022.1043189] [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: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 01/29/2023] Open
Abstract
Background Population aging accompanied by multimorbidity imposes a great burden on households and the healthcare system. This study aimed to determine the incidence and determinants of catastrophic health expenditure (CHE) in the households of old people with multimorbidity in China. Methods Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2018, with 3,511 old people (≥60 years) with multimorbidity responding to the survey on behalf of their households. CHE was identified using two thresholds: ≥10% of out-of-pocket (OOP) health spending in total household expenditure (THE) and ≥40% of OOP health spending in household capacity to pay (CTP) measured by non-food household expenditure. Logistic regression models were established to identify the individual and household characteristics associated with CHE incidence. Results The median values of THE, OOP health spending, and CTP reached 19,900, 1,500, and 10,520 Yuan, respectively. The CHE incidence reached 31.5% using the ≥40% CTP threshold and 45.6% using the ≥10% THE threshold. It increased by the number of chronic conditions reported by the respondents (aOR = 1.293-1.855, p < 0.05) and decreased with increasing household economic status (aOR = 1.622-4.595 relative the highest quartile, p < 0.001). Hospital admissions over the past year (aOR = 6.707, 95% CI: 5.186 to 8.674) and outpatient visits over the past month (aOR = 4.891, 95% CI: 3.822 to 6.259) of the respondents were the strongest predictors of CHE incidence. The respondents who were male (aOR = 1.266, 95% CI: 1.054 to 1.521), married (OR = 1.502, 95% CI: 1.211 to 1.862), older than 70 years (aOR = 1.288-1.458 relative to 60-69 years, p < 0.05), completed primary (aOR = 1.328 relative to illiterate, 95% CI: 1.079 to 1.635) or secondary school education (aOR = 1.305 relative to illiterate, 95% CI: 1.002 to 1.701), lived in a small (≤2 members) household (aOR = 2.207, 95% CI: 1.825 to 2.669), and resided in the northeast region (aOR = 1.935 relative to eastern, 95% CI: 1.396 to 2.682) were more likely to incur CHE. Conclusion Multimorbidity is a significant risk of CHE. Household CHE incidence increases with the number of reported chronic conditions. Socioeconomic and regional disparities in CHE incidence persist in China.
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Affiliation(s)
- Haofei Li
- Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, China
| | - Enxue Chang
- Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, China
| | - Wanji Zheng
- Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, China
| | - Bo Liu
- Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, China
| | - Juan Xu
- Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, China
| | - Wen Gu
- Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, China
| | - Lan Zhou
- Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, China
| | - Jinmei Li
- Heilongjiang Medical Service Management Evaluation Center, Harbin, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia,Chaojie Liu
| | - Hongjuan Yu
- Department of Hematology, The First Affiliated Hospital, Harbin Medical University, Harbin, China,Hongjuan Yu
| | - Weidong Huang
- Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, China,*Correspondence: Weidong Huang
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Ipinnimo TM, Durowade KA. Catastrophic Health Expenditure and Impoverishment from Non-Communicable Diseases: A comparison of Private and Public Health Facilities in Ekiti State, Southwest Nigeria. Ethiop J Health Sci 2022; 32:993-1006. [PMID: 36262712 PMCID: PMC9554780 DOI: 10.4314/ejhs.v32i5.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/15/2022] [Indexed: 11/07/2022] Open
Abstract
Background Catastrophic health expenditure and impoverishment are the outcomes of poor financing mechanisms. Little is known about the prevalence and predictors of these outcomes among non-communicable disease patients in private and public health facilities. Methods A health facility-based comparative cross-sectional study was conducted among 360 patients with non-communicable diseases (180 per group) selected through multistage sampling. Data were collected with a semi-structured, interviewer-administered questionnaire and analyzed with IBM SPSS for Windows, Version 22.0. Two prevalences of catastrophic health expenditure were calculated utilizing both the World Bank (CHE1) and the WHO (CHE2) methodological thresholds. Results The prevalence of CHE1 (Private:42.2%, Public:21.7%, p<0.001) and CHE2 (Private:46.8%, Public:28.0%, p<0.001) were higher in private health facilities. However, there was no significant difference between the proportion of impoverishment (Private:24.3%, Public:30.9%, p=0.170). The identified predictors were occupation, number of complications and clinic visits for catastrophic health expenditure and socioeconomic status for impoverishment in private health facilities. Level of education, occupation, socioeconomic status, number of complications and alcohol predicted catastrophic health expenditure while the level of education, socioeconomic status and the number of admissions predicted impoverishment in public health facilities. Conclusions Catastrophic health expenditure and impoverishment were high among the patients, with the former more prevalent in private health facilities. Therefore, we recommend expanding the coverage and scope of national health insurance among these patients to provide them with financial risk protection. Identified predictors should be taken into account by the government and other stakeholders when designing policies to limit catastrophic health expenditure and impoverishment among them.
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Affiliation(s)
- Tope Michael Ipinnimo
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Kabir Adekunle Durowade
- Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria and Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
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8
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Gilmour B, Xu Z, Bai L, Addis Alene K, Clements ACA. Risk factors associated with unsuccessful tuberculosis treatment outcomes in Hunan Province, China. Trop Med Int Health 2022; 27:290-299. [PMID: 35014123 PMCID: PMC9305245 DOI: 10.1111/tmi.13720] [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] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Globally, China has the third highest number of tuberculosis (TB) cases despite high rates (85.6%) of effective treatment coverage. Identifying risk factors associated with unsuccessful treatment outcomes is an important component of maximizing the efficacy of TB control programs. METHODS Retrospective cohort study to evaluate the outcomes of 306,860 drug-susceptible TB patients who underwent treatment in Hunan Province, China between 2013 and 2018. Univariable and multivariable logistic regression models were used to identify factors associated with unsuccessful TB treatment outcomes. RESULTS A successful treatment outcome was recorded for 98.6% of patients, defined as the sum of patients who were cured (36.2%) and completed treatment (62.4%). An unsuccessful treatment outcome was recorded for 1.8% of patients, defined as the sum of treatment failure (1.1%), deaths (0.5%) and lost to follow up (0.2%). The odds of an unsuccessful treatment outcome showed an increasing trend in more recent years of registration (2018 Adjusted Odds Ratio (AOR): 1.43; 95% Confidence Interval (CI) 1.31, 1.57 relative to 2013). Other significant risk factors were male sex (AOR: 1.17; 95% CI 1.10, 1.25); increasing age (AOR:1.02 per year increase; 95% CI 1.02,1.02); being severely ill (AOR: 1.50; 95% CI 1.33, 1.70); having a history of TB treatment (AOR: 2.93; 95% CI 2.69, 3.20); not being under systematic management (AOR: 16.10 (14.49, 17.88) and treatment regimens that differed from full course management. CONCLUSIONS The increasing likelihood of an unsuccessful treatment outcome over time necessitates the need for further research.
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Affiliation(s)
- Beth Gilmour
- Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Zuhui Xu
- Xiangya School of Public Health, Central South University, Changsha, China.,TB Control Institute of Hunan Province, Changsha, China
| | - Liqiong Bai
- TB Control Institute of Hunan Province, Changsha, China
| | - Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
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9
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Obembe TA, Levin J, Fonn S. Prevalence and factors associated with catastrophic health expenditure among slum and non-slum dwellers undergoing emergency surgery in a metropolitan area of South Western Nigeria. PLoS One 2021; 16:e0255354. [PMID: 34464387 PMCID: PMC8407567 DOI: 10.1371/journal.pone.0255354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Out of Pocket (OOP) payment continues to persist as the major mode of payment for healthcare in Nigeria despite the introduction of the National Health Insurance Scheme (NHIS). Although the burden of health expenditure has been examined in some populations, the impact of OOP among slum dwellers in Nigeria when undergoing emergencies, is under-researched. This study sought to examine the prevalence, factors and predictors of catastrophic health expenditure amongst selected slum and non-slum communities undergoing emergency surgery in Southwestern Nigeria. METHODS The study utilised a descriptive cross-sectional survey design to recruit 450 households through a multistage sampling technique. Data were collected using pre-tested semi-structured questionnaires in 2017. Factors considered for analysis relating to the payer were age, sex, relationship of payer to patient, educational status, marital status, ethnicity, occupation, income and health insurance coverage. Variables factored into analysis for the patient were indication for surgery, grade of hospital, and type of hospital. Households were classified as incurring catastrophic health expenditure (CHE), if their OOP expenditure exceeded 5% of payers' household budget. Analysis of the data took into account the multistage sampling design. RESULTS Overall, 65.6% (95% CI: 55.6-74.5) of the total population that were admitted for emergency surgery, experienced catastrophic expenditure. The prevalence of catastrophic expenditure at 5% threshold, among the population scheduled for emergency surgeries, was significantly higher for slum dwellers (74.1%) than for non-slum dwellers (47.7%) (F = 8.59; p = 0.019). Multiple logistic regression models revealed the significant independent factors of catastrophic expenditure at the 5% CHE threshold to include setting of the payer (whether slum or non-slum dweller) (p = 0.019), and health insurance coverage of the payer (p = 0.012). Other variables were nonetheless significant in the bivariate analysis were age of the payer (p = 0.017), income (p<0.001) and marital status of the payer (p = 0.022). CONCLUSION Although catastrophic health expenditure was higher among the slum dwellers, substantial proportions of respondents incurred catastrophic health expenditure irrespective of whether they were slum or non-slum dwellers. Concerted efforts are required to implement protective measures against catastrophic health expenditure in Nigeria that also cater to slum dwellers.
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Affiliation(s)
- Taiwo A. Obembe
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jonathan Levin
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Sharon Fonn
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Shumet Y, Mohammed SA, Kahissay MH, Demeke B. Catastrophic Health Expenditure among Chronic Patients Attending Dessie Referral Hospital, Northeast Ethiopia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:99-107. [PMID: 33568923 PMCID: PMC7868221 DOI: 10.2147/ceor.s291463] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Catastrophic health expenditure is health spending that is not covered by a health-care plan. These costs tend to escalate over time, due to chronic illnesses. Catastrophic health expenditure leads to decreased use of health services and poorer treatment outcomes. This study measured the extent of and factors associated with catastrophic health expenditure among chronically ill patients attending Dessie Referral Hospital in northeast Ethiopia. METHODS An institution-based cross-sectional study design was used to quantify catastrophic health expenditure among 302 chronically ill patients from May 25, 2018 to June 30, 2018. A stratified sampling technique was used to select the study participants. Descriptive and inferential statistics were computed using SPSS 20. RESULTS Catastrophic health expenditure was found in 194 (64.2%, 95% CI 58.8%-70.5%) of chronic patients. Costly service (151, 50%), transport (104, 34.4%), and pharmaceuticals (189, 62.6%) were the reasons for catastrophic health expenditure among chronic patients. Factors associated with catastrophic health expenditure were age <30 years (AOR 7.74, CI 0.94-63.62; P=0.01), patient monthly income CONCLUSION Two-thirds of chronic patients had catastrophic health expenditure. Starting and strengthening various health-insurance schemes will make chronic-care services more accessible and affordable.
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Affiliation(s)
- Yohannes Shumet
- Department of Pharmacy, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Ahmed Mohammed
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Mesfin Haile Kahissay
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Birhanu Demeke
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Ren J, Han D, Zhang J, Wang Y, Huang Q, Tian T, Li X. Development and Psychometric Testing of the Supportive Care Needs Scale for Patients with Tuberculosis (SCN-TB). Patient Prefer Adherence 2021; 15:2267-2278. [PMID: 34675491 PMCID: PMC8502070 DOI: 10.2147/ppa.s330225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patients affected by tuberculosis have diverse unmet supportive care needs (SCN) that may seriously affect their treatment adherence. Accurately assessing patients' SCN is important for providing efficient patient-centred care, but few instruments are suitable for use in clinical practice. Therefore, the purpose of this study was to develop an SCN scale for patients with tuberculosis (SCN-TB) and to evaluate its psychometrical properties. PATIENTS AND METHODS Based on the SCN framework, the SCN-TB was designed via a literature review, Delphi consultation and pilot study. Then, 550 patients from four tuberculosis specialist hospitals in Shaanxi Province were enrolled by convenience sampling to further test the validity and reliability of the SCN-TB. RESULTS A total of 518 patients completed the survey. The final scale encompasses 25 items in five domains: physical, practical, psycho-emotional, social, and informational. The content validity for the scale was 0.93, with that for each item ranging from 0.80 to 1.00. Five factors that explained 80.38% of the variance were identified in exploratory factor analysis. A five-factor model was then confirmed with confirmatory factor analysis using maximum likelihood estimation with bootstrapping. The model fit indices were χ 2/df=1.062 (Bollen-Stine χ 2=281.382, df=265, p<0.001), CFI=0.997, RMSEA=0.016, SRMR=0.053, NFI=0.951, and GFI=0.929. All factors had acceptable convergent and discriminant validity. The Cronbach's α, split-half, and test-retest reliability coefficients of the scale were 0.884, 0.883, and 0.854, respectively. CONCLUSION The SCN-TB is a valid and reliable theory based tool for assessing the needs of patients with tuberculosis and can be applied in both clinical practice and research.
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Affiliation(s)
- Jing Ren
- School of Nursing, Health Science Center, Xi’an Jiaotong University, Xi’an City, People’s Republic of China
| | - Dongfang Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an City, People’s Republic of China
| | - Jingjun Zhang
- School of Nursing, Health Science Center, Xi’an Jiaotong University, Xi’an City, People’s Republic of China
| | - Yingli Wang
- Department of Internal Medicine of Tuberculosis, Fourth Hospital of Inner Mongolia Autonomous Region, Hohhot City, People’s Republic of China
| | - Qiaoqiao Huang
- Department of Nursing, Fourth Hospital of Inner Mongolia Autonomous Region, Huhhot City, People’s Republic of China
| | - Tian Tian
- School of Nursing, Health Science Center, Xi’an Jiaotong University, Xi’an City, People’s Republic of China
| | - Xiaomei Li
- School of Nursing, Health Science Center, Xi’an Jiaotong University, Xi’an City, People’s Republic of China
- Correspondence: Xiaomei Li School of Nursing, Health Science Center, Xi’an Jiaotong University, No. 76 Yanta West Road, Yanta District, Xi’an City, Shanxi, 710061, People’s Republic of ChinaTel/Fax +86 29 82657017 Email
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Fuady A, Houweling TAJ, Richardus JH. COVID-19 and Tuberculosis-Related Catastrophic Costs. Am J Trop Med Hyg 2020; 104:436-440. [PMID: 33269683 PMCID: PMC7866313 DOI: 10.4269/ajtmh.20-1125] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022] Open
Abstract
The COVID-19 pandemic has created an unprecedented health crisis and a substantial socioeconomic impact. It also affects tuberculosis (TB) control severely worldwide. Interruptions of many TB control programs because of the COVID-19 pandemic could result in significant setbacks. One of the targets that can be affected is the WHO's End TB Strategy goal to eliminate catastrophic costs of TB-affected households by 2030. Disruptions to TB programs and healthcare services due to COVID-19 could potentially prolong diagnostic delays and worsen TB treatment adherence and outcomes. The economic recession caused by the pandemic could significantly impact household financial capacity because of the reduction of income and the rise in unemployment rates. All of these factors increase the risk of TB incidence and the gravity of economic impact on TB-affected households, and hamper efforts to eliminate catastrophic costs and control TB. Therefore, efforts to eliminate the incidence of TB-affected households facing catastrophic costs will be very challenging. Because financial constraint plays a significant role in TB control, the improvement of health and social protection systems is critical. Even before the pandemic, many TB-high-burden countries (HBCs) lacked robust health and social protection systems. These challenges highlight the substantial need for a more robust engagement of patients and civil society organizations and international support in addressing the consequences of COVID-19 on the control of TB.
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Affiliation(s)
- Ahmad Fuady
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tanja A. J. Houweling
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Zhang P, Xu G, Song Y, Tan J, Chen T, Deng G. Challenges Faced by Multidrug-Resistant Tuberculosis Patients in Three Financially Affluent Chinese Cities. Risk Manag Healthc Policy 2020; 13:2387-2394. [PMID: 33173363 PMCID: PMC7648070 DOI: 10.2147/rmhp.s275400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to analyze socioeconomic burdens and other difficulties that multidrug-resistant tuberculosis (MDR-TB) patients in cities are facing, to identify major obstacles and which groups of patients are most affected. Methods Face-to-face and phone-call interviews were conducted in early 2018 to follow-up with patients newly diagnosed with MDR-TB in 2017 in three tuberculosis hospitals in three financially affluent Chinese cities. Demographic data and information on their medical care, insurance coverage, and medical expenses were collected and analyzed. Results A total of 144 newly diagnosed MDR-TB cases were reviewed during the study period, excluding 38 who were lost to follow-up and 29 patients who refused to participate, 77 patients were enrolled in this study. A total of 61 (79%) of these patients were hospitalized after MDR-TB diagnosis with an average hospital stay of 14 days, of them 57 (74%) were sputum positive on diagnosis. The proportion of patients who failed community care were 48% married, 56% in white collar employment and 43% in temp jobs/unemployed. In terms of insurance coverage, the proportion of patients who failed community care were 23% with no insurance and/or New Rural Co-operative Medical Care Scheme (NRCMS) and 45% with Urban Employee Basic Medical Insurance (UEBMI)/Urban Residents Basic Medical Insurance (URBMI) and commercial insurance. Difficulties patients encountered were, financial pressure (33%), psychological stress (26%), adverse drug reactions (23%), repulsive reaction to injections (17%). Fourty-eight percent of the patients spent over ¥2000 (USD300) per month on TB treatment. Conclusion Despite insurance coverage, financial hardship remains the number one difficulty MDR-TB patients encountered in relatively financially affluent cities. Among them, the married working class were found to be the most financially sensitive group and have the highest tendency to fail community care. It is of utmost urgency to enhance the current medical policy to improve treatment adherence.
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Affiliation(s)
- Peize Zhang
- Department of Pulmonary Medicine & Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, People's Republic of China
| | - Guanghui Xu
- Jiangmen Institute of Tuberculosis Prevention and Control, Guangdong, People's Republic of China
| | - Yanhua Song
- Department of Tuberculosis, Chest Hospital of Peking, Beijing, People's Republic of China
| | - Jie Tan
- Department of Pulmonary Medicine & Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, People's Republic of China
| | - Tao Chen
- Department of Pulmonary Medicine & Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, People's Republic of China
| | - Guofang Deng
- Department of Pulmonary Medicine & Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, People's Republic of China
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Lu L, Jiang Q, Hong J, Jin X, Gao Q, Bang H, DeRiemer K, Yang C. Catastrophic costs of tuberculosis care in a population with internal migrants in China. BMC Health Serv Res 2020; 20:832. [PMID: 32887605 PMCID: PMC7602335 DOI: 10.1186/s12913-020-05686-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The internal rural-to-urban migration is one of the major challenges for tuberculosis (TB) control in China. Patient costs incurred during TB diagnosis and treatment could cause access and adherence barriers, particularly among migrants. Here, we estimated the prevalence of catastrophic costs of TB patients and its associated factors in an urban population with internal migrants in China. METHODS A cross-sectional survey was conducted to enroll culture-confirmed pulmonary TB patients in Songjiang district, Shanghai, between December 1, 2014, and December 31, 2015. Consenting participants completed a questionnaire, which collected direct and indirect costs before and after the diagnosis of TB. The catastrophic cost was defined as the annual expenses of TB care that exceeds 20% of total household disposable income. We used logistic regression to identify factors associated with catastrophic costs. RESULTS Overall, 248 drug-susceptible TB patients were enrolled, 70% (174/248) of them were from migrants. Migrant patients were significantly younger compared to resident patients. The total costs were 25,824 ($3689) and 13,816 ($1974) Chinese Yuan (RMB) in average for resident and migrant patients, respectively. The direct medical cost comprised about 70% of the total costs among both migrant and resident patients. Overall, 55% (132 of 248) of patients experienced high expenses (>10% of total household income), and 22% (55 of 248) experienced defined catastrophic costs. The reimbursement for TB care only reduced the prevalence of catastrophic costs to 20% (49 of 248). Meanwhile, 52% (90 of 174) of the internal migrants had no available local health insurance. Hospitalizations, no available insurance, and older age (> 45-year-old) contributed significantly to the occurrence of catastrophic costs. CONCLUSIONS The catastrophic cost of TB service cannot be overlooked, despite the free policy. Migrants have difficulties benefiting from health insurance in urban cities. Interventions, including expanded medical financial assistance, are needed to secure universal TB care.
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Affiliation(s)
- Liping Lu
- Department of Tuberculosis Control, Songjiang District Center for Disease Control and Prevention, Shanghai, China
| | - Qi Jiang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jianjun Hong
- Department of Tuberculosis Control, Songjiang District Center for Disease Control and Prevention, Shanghai, China
| | - Xiaoping Jin
- Department of Tuberculosis Control, Songjiang District Center for Disease Control and Prevention, Shanghai, China
| | - Qian Gao
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Heejung Bang
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Kathryn DeRiemer
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Chongguang Yang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China.
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT, 06510, USA.
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Sui M, Zeng X, Tan WJ, Tao S, Liu R, Liu B, Ma W, Huang W, Yu H. Catastrophic health expenditures of households living with pediatric leukemia in China. Cancer Med 2020; 9:6802-6812. [PMID: 32697427 PMCID: PMC7520357 DOI: 10.1002/cam4.3317] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/07/2020] [Accepted: 06/29/2020] [Indexed: 11/11/2022] Open
Abstract
Background Leukemia can create a significant economic burden on the patients and their families. The objective of this study is to assess the medical expenditure and compensation of pediatric leukemia, and to explore the incidence and determinants of catastrophic health expenditure (CHE) among households with pediatric leukemia patients in China. Methods A cross‐sectional interview was conducted among households living with pediatric leukemia using a questionnaire in two tertiary hospitals. CHE was defined as out‐of‐pocket (OOP) payments that were greater than or equal to 40% of a household's capacity to pay (CTP). Chi‐square tests and logistic regression analysis were performed to identify the determinants of CHE. Results Among 242 households living with pediatric leukemia, the mean OOP payment for pediatric leukemia healthcare was $9860, which accounted for approximately 35.7% of the mean household's CTP. The overall incidence of CHE was 43.4% and showed a downward trend with the lowest income group at 69.0% to the highest income group at 16.1%. The logistic regression model found that medical insurance, frequency of hospital admissions, charity assistance, and income level were significant predictors of CHE. Conclusion The results revealed that pediatric leukemia had a significant catastrophic effect on families, especially those with lower economic status. The occurrence of CHE in households living with pediatric leukemia could be reduced by addressing income disparity. In addition, extending coverage and improving compensation from medical insurance could also alleviate CHE. Some other measures that can be implemented are to address the barriers of charity assistance for vulnerable groups.
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Affiliation(s)
- Mingjie Sui
- School of Health Management, Harbin Medical University, Harbin, China
| | - Xueyun Zeng
- School of Health Management, Harbin Medical University, Harbin, China
| | - Wan Jie Tan
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Sihai Tao
- North China University of Science and Technology, Hebei, China
| | - Rui Liu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Bo Liu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Wenrui Ma
- School of Public Health, The University of Queensland, Brisbane, Qld, Australia
| | - Weidong Huang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Hongjuan Yu
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Li H, Cheng B, Chen Y. What causes high costs for rural tuberculosis inpatients? Evidence from five counties in China. BMC Infect Dis 2020; 20:501. [PMID: 32652944 PMCID: PMC7353759 DOI: 10.1186/s12879-020-05235-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 07/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) still causes high economic burden on patients in China, especially for rural patients. Our study aims to explore the risk factors associated with the high costs for TB inpatients in rural China from the aspects of inpatients' socio-demographic and institutional attributes. METHODS Generalized linear models were utilized to investigate the factors associated with TB inpatients' total costs and out-of-pocket (OOP) expenditures. Quantile regression (QR) models were applied to explore the effect of each factor across the different costs range and identify the risk factors of high costs. RESULTS TB inpatients with long length of stay and who receive hospitalization services cross provincially, in tertiary and specialized hospitals were likely to face high total costs and OOP expenditures. QR models showed that high total costs occurred in Dingyuan and Funan Counties, but they were not accompanied by high OOP expenditures. CONCLUSIONS Early diagnosis, standard treatment and control of drug-resistant TB are still awaiting for more efforts from the government. TB inpatients should obtain medical services from appropriate hospitals. The diagnosis and treatment process of TB should be standardized across all designated medical institutions. Furthermore, the reimbursement policy for migrant workers who suffered from TB should be ameliorated.
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Affiliation(s)
- Haomiao Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060 China
- Institute of Model Animals of Wuhan University, Wuhan, 430072 China
- Research center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, 430030 Hubei China
| | - Bin Cheng
- China National Health Development Research Center, Beijing, 100044 China
| | - Yingchun Chen
- Research center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, 430030 Hubei China
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China
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Wang Y, McNeil EB, Huang Z, Chen L, Lu X, Wang C, Chen H, Chongsuvivatwong V. Household financial burden among multidrug-resistant tuberculosis patients in Guizhou province, China: A cross-sectional study. Medicine (Baltimore) 2020; 99:e21023. [PMID: 32664107 PMCID: PMC7360282 DOI: 10.1097/md.0000000000021023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) threatens global public health. Poor access to health care due to financial hardship contributes to further transmission of the disease. The study aimed to:A cross-sectional study was conducted in 2 hospitals designated for MDR-TB from January to August 2018. Data were collected by interviewing eligible MDR-TB outpatients and reviewing the medical records. The magnitude of financial burden was documented by total cost and distribution of cost components. Catastrophic payments were measured by 2 indicators: catastrophic health expenditure (CHE) and catastrophic total costs (CTC), both of which were estimated by incidence and intensity. Their associated factors were determined using logistic regression models.Of 161 households affected by MDR-TB, the average total costs due to MDR-TB treatment in the first year was US$ 8266 and consisted of 72% direct medical costs, 5% direct non-medical costs and 23% indirect costs (income loss). Thirty seven percent of direct medical costs were covered by insurance. Overall, the incidence of CHE and CTC was 68.3% and 87.0%, respectively. Both incidence and intensity for the 2 defined catastrophic costs increased when a households income decreased. Five significant factors of catastrophic costs were low household income, absence of students in a family, hospital length of stay, male gender, and job/productivity loss.Households with MDR-TB patients shouldered a high financial burden which was mainly driven by direct medical costs and income loss in Guizhou. Greater catastrophic payments were associated with hospital length of stay and socioeconomic status, especially had a dose-response relationship with households income. Our findings suggest that financial and social protection of local policies for MDR-TB should be improved by preparing a uniform and comprehensive insurance package to cover sufficiently direct medical costs, and introducing social pro-poor assistance policies for risk families to protect them from financial hardship.
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Affiliation(s)
- Yun Wang
- Department of Health Service Management, School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, China
| | - Edward B. McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Zhongfeng Huang
- Department of Tuberculosis, Guiyang Public Health Clinical Center, Guiyang
| | - Ling Chen
- Department of Respiratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi
| | - Xiaolong Lu
- Department of Health Service Management, School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, China
| | - Chengqiong Wang
- Department of Respiratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi
| | - Huijuan Chen
- Department of Tuberculosis Prevention and Control, Guizhou Center for Disease Prevention and Control, Guiyang, Guizhou, China
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Yang T, Chen T, Che Y, Chen Q, Bo D. Factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in China. BMC Public Health 2020; 20:1009. [PMID: 32586305 PMCID: PMC7318445 DOI: 10.1186/s12889-020-09136-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/17/2020] [Indexed: 12/02/2022] Open
Abstract
Background Certain districts and counties in China designated local general hospital as the designated hospital for tuberculosis (TB) management after the promulgation of the Law of Practicing Physicians in 2009. To our knowledge, there is limited research on catastrophic payments of TB patients under this service model, often with inconsistent conclusions. In addition, there has been no published studies from China using the updated 2018 World Health Organization (WHO) definition of catastrophic total costs due to TB. This study used the latest criterion recommended by the WHO to analyze the incidence of catastrophic total costs for households affected by TB under the designated hospital model and explore its influencing factors. Methods A cross-sectional analysis was carried out in all ten designated hospitals in Ningbo, China. Eligible pulmonary TB cases confirmed by sputum culture of Mycobacterium tuberculosis were recruited and surveyed from September 2018 to October 2018. We evaluated catastrophic total costs using total costs for TB treatment exceeding 20% of the household’s annual pre-TB income. A sensitivity analysis was performed while varying the thresholds. The least absolute shrinkage and selection operator (LASSO) regression were applied to select variables, and multiple logistic regression analysis were used to identify the determinants of catastrophic total costs. Results A total of 672 patients were included, with a median age of 41 years old. The rate of catastrophic total costs of surveyed households was 37.1%, and that of households affected by MDR was 69.6%. Medical cost accounted for more than 60% of the total cost. 57.7% cases were hospitalized. The hospitalization rates of patients with no comorbidities, no severe adverse drug reactions, and rifampin-sensitive TB were 53.9, 54.9, and 55.3%, respectively. Patients in the poorest households had the highest hospitalization rates (Q1:54.8%, Q2:61.4%, Q3:52.2%, Q4:49.5%, Q5:69.7%, P = 0.011) and the highest incidence of severe adverse drug reactions (Q1:29.6%, Q2:19.6%, Q3:28.0%, Q4:33.7%, Q5:35.3%, P = 0.034). Factors such as elderly, minimum living security, unemployed before or after illness, poor economic status, seeking medical care outside the city, hospitalization, absence of local basic medical insurance coverage and MDR were positively associated with catastrophic costs. Conclusion Substantial proportions of patients and households affected by pulmonary TB faced catastrophic economic risks in Ningbo, China. The existing policies that focus on expanding the coverage of basic medical insurance and economic protection measures (such as cash transfers to compensate low-income households for direct non-medical costs and income loss) might be insufficient. Tailored program that mitigate inappropriate healthcare and address equity of care delivery are worthy of attention.
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Affiliation(s)
- Tianchi Yang
- Institute of Tuberculosis Prevention and Control, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang, China.
| | - Tong Chen
- Institute of Tuberculosis Prevention and Control, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang, China
| | - Yang Che
- Institute of Tuberculosis Prevention and Control, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang, China
| | - Qin Chen
- Division of Medical Insurance, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Dingyi Bo
- Institute of Infectious Disease Control, Haishu District Center for Disease Control and Prevention, Ningbo, Zhejiang, China
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Sweeney S, Vassall A, Guinness L, Siapka M, Chimbindi N, Mudzengi D, Gomez GB. Examining Approaches to Estimate the Prevalence of Catastrophic Costs Due to Tuberculosis from Small-Scale Studies in South Africa. PHARMACOECONOMICS 2020; 38:619-631. [PMID: 32239479 PMCID: PMC7307451 DOI: 10.1007/s40273-020-00898-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE In context of the End TB goal of zero tuberculosis (TB)-affected households encountering catastrophic costs due to TB by 2020, the estimation of national prevalence of catastrophic costs due to TB is a priority to inform programme design. We explore approaches to estimate the national prevalence of catastrophic costs due to TB from existing datasets as an alternative to nationally representative surveys. METHODS We obtained, standardized and merged three patient-level datasets from existing studies on patient-incurred costs due to TB in South Africa. A deterministic cohort model was developed with the aim of estimating the national prevalence of catastrophic costs, using national data on the prevalence of TB and likelihood of loss to follow-up by income quintile and HIV status. Two approaches were tested to parameterize the model with existing cost data. First, a meta-analysis summarized study-level data by HIV status and income quintile. Second, a regression analysis of patient-level data also included employment status, education level and urbanicity. We summarized findings by type of cost and examined uncertainty around resulting estimates. RESULTS Overall, the median prevalence of catastrophic costs for the meta-analysis and regression approaches were 11% (interquartile range [IQR] 9-13%) and 6% (IQR 5-8%), respectively. Both approaches indicated that the main burden of catastrophic costs falls on the poorest households. An individual-level regression analysis produced lower uncertainty around estimates than a study-level meta-analysis. CONCLUSIONS This paper presents a novel application of existing data to estimate the national prevalence of catastrophic costs due to TB. This type of model could be useful for researchers and policy makers looking to inform certain policy decisions; however, some uncertainties remain due to limitations in data availability. There is an urgent need for standardized reporting of cost data and improved guidance on methods to collect income data to improve these estimates going forward.
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Affiliation(s)
- Sedona Sweeney
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Room 327, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Room 327, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Lorna Guinness
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Room 327, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Mariana Siapka
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Room 327, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | | | | | - Gabriela B Gomez
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Room 327, 15-17 Tavistock Place, London, WC1H 9SH, UK
- Vaccine Epidemiology and Modelling, Sanofi Pasteur SA, Lyon, France
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Cost of Tuberculosis Care in Programmatic Settings from Karnataka, India: Is It Catastrophic for the Patients? Tuberc Res Treat 2020; 2020:3845694. [PMID: 32455013 PMCID: PMC7238341 DOI: 10.1155/2020/3845694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/19/2020] [Accepted: 04/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background TB diagnostic and treatment services in India are provided free of cost in the programmatic context across the country. There are different costs incurred during health care utilization, and this study was conducted to estimate such costs. Methodology. A longitudinal study was conducted among patients of three urban tuberculosis units (TUs) of Davangere, Belagavi, and Bengaluru, Karnataka. Trained data collectors administered a validated questionnaire and recorded monthly costs incurred by the patients which are expressed in median Indian National Rupees (INR). The analysis was done using SPSS version 23.0. A p value of <0.05 was taken as statistically significant. Results Among 214 patients, about 37%, 42%, and 21% belonged to Davangere, Belagavi, and Bengaluru, respectively. Median total pre- and postdiagnostic costs incurred across the three TUs were 3800 and 4000 INR, respectively. The direct nonmedical cost was higher for accommodation (median cost of 800 INR) and direct medical cost for non-TB drugs (median cost of 2000 INR). However, maximum direct medical and nonmedical costs were attributed to hospital admissions (1200 INR) and accommodation costs (700 INR) in the postdiagnostic period, respectively. The median indirect cost incurred was 300 INR overall, and the maximum total indirect cost was 40000 INR in the postdiagnostic period. About one-third of patients faced loss of income and 19.6% faced coping costs. Patients spent about 6.7% (0.97%–52.3%) of their income on TB treatment. About 12.3% patients faced catastrophic expenditure. Median cost was significantly higher among those seeking private health care facilities (12100 INR in private vs. 6800 INR in public; p < 0.05) during the prediagnostic period. Prediagnostic and diagnostic out-of-pocket expenditures (OPE) were significantly higher across all the three centres (p < 0.05). Conclusion The TB patients experienced untoward expenditure under programmatic settings. The costs encountered by one in eight patients were catastrophic by nature.
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Zhang X, Xu Q, Guo X, Jing Z, Sun L, Li J, Zhou C. Catastrophic health expenditure: a comparative study between hypertensive patients with and without complication in rural Shandong, China. BMC Public Health 2020; 20:545. [PMID: 32321485 PMCID: PMC7178564 DOI: 10.1186/s12889-020-08662-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 04/06/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Some previous studies have assessed catastrophic health expenditure (CHE) in households with hypertensive patients, but few have examined the difference of CHE in hypertensive patients with and without complications. The purpose of this study is to compare the incidence and determinants of CHE between hypertensive patients with and without complications. METHODS Data of this study were from a cross-sectional study in Shandong Province in China in 2016. Of the recruited 3457 hypertensive patients registered in the NCDs management system in the sampling villages, 3113 completed the survey, with a response rate of 90.05%.CHE was defined as out-of-pocket payments for hypertensive care that equaled or exceeded 40% of the household capacity to pay (non-food expenditure). Hypertension complications (e.g., stroke, coronary heart disease, hypertensive kidney disease, etc.) were collected in this study, which was categorized into 0 (no), 1(single), and 2 and more according to the types of hypertensive complications. We employed Chi-square test to explore associated factors and logistic regression model to identify the determinants of CHE. RESULTS The incidence of CHE and impoverishment is 13.6 and 10.8% among hypertensive patients. The incidence of CHE with one complication is 25.3% (Ρ = 0.000, OR = 2.29) and 47.3% (P = 0.000, OR = 3.60) in patients with two or more complications, which are both statistically higher than that in patients without complication (6.1%). Across all types of patients, income levels are inversely related to the incidence of CHE. Patients who use outpatient or inpatient service are more likely to experience CHE (Ρ = 0.000). Factors including living arrangements, family size, educational attainment are found to be significantly associated with CHE in some subgroups (Ρ <0.05). CONCLUSIONS CHE and impoverishment incidence among hypertensive patients are both high in rural China. Patients with hypertensive complication are at higher catastrophic risk than those without complication. More attention needs to be paid to households with hypertension patients, especially for those with hypertension complications.
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Affiliation(s)
- Xinyi Zhang
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Qiongqiong Xu
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, Jinan, 250014 China
| | - Zhengyue Jing
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Long Sun
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Jiajia Li
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Chengchao Zhou
- School of Public Health, Shandong University, Jinan, 250012 China
- NHC Key Lab of Health Econonics and Policy Research, Shandong University, Jinan, 250012 China
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Huang F, Wang N, Li Y, Zhang H, Yuan Y, Wang X, Wang X, Huan S, Wang L, Chen M, Zhao Y. Multichannel Financing Reduces Economic Burden and Improves the Medical Security Level for Tuberculosis Patients. China CDC Wkly 2020; 2:194-197. [PMID: 34594622 PMCID: PMC8393168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/18/2020] [Indexed: 11/02/2022] Open
Affiliation(s)
- Fei Huang
- National Center for Tuberculosis Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Ni Wang
- National Center for Tuberculosis Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - You Li
- National Center for Tuberculosis Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Yanli Yuan
- Jilin Provincial Center for Tuberculosis Control and Prevention, Changchun, Jilin, China
| | - Xiaomeng Wang
- Zhejiang Provincial Center for Tuberculosis Control and Prevention, Hangzhou, Zhejiang, China
| | - Xiaolin Wang
- Ningxia Hui Autonomous Region Tuberculosis Dispensary, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Shitong Huan
- Bill & Melinda Gates Foundation, Beijing office, Beijing, China
| | - Lixia Wang
- National Center for Tuberculosis Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Mingting Chen
- National Center for Tuberculosis Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Yanlin Zhao
- National Center for Tuberculosis Control and Prevention, China Center for Disease Control and Prevention, Beijing, China,Yanlin Zhao,
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Wang Y, Xu C, Ren J, Wu W, Zhao X, Chao L, Liang W, Yao S. Secular Seasonality and Trend Forecasting of Tuberculosis Incidence Rate in China Using the Advanced Error-Trend-Seasonal Framework. Infect Drug Resist 2020; 13:733-747. [PMID: 32184635 PMCID: PMC7062399 DOI: 10.2147/idr.s238225] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/25/2020] [Indexed: 12/27/2022] Open
Abstract
Objective Tuberculosis (TB) is a major public health problem in China, and contriving a long-term forecast is a useful aid for better launching prevention initiatives. Regrettably, such a forecasting method with robust and accurate performance is still lacking. Here, we aim to investigate its potential of the error-trend-seasonal (ETS) framework through a series of comparative experiments to analyze and forecast its secular epidemic seasonality and trends of TB incidence in China. Methods We collected the TB incidence data from January 1997 to August 2019, and then partitioning the data into eight different training and testing subsamples. Thereafter, we constructed the ETS and seasonal autoregressive integrated moving average (SARIMA) models based on the training subsamples, and multiple performance indices including the mean absolute deviation, mean absolute percentage error, root-mean-squared error, and mean error rate were adopted to assess their simulation and projection effects. Results In the light of the above performance measures, the ETS models provided a pronounced improvement for the long-term seasonality and trend forecasting in TB incidence rate over the SARIMA models, be it in various training or testing subsets apart from the 48-step ahead forecasting. The descriptive results to the data revealed that TB incidence showed notable seasonal characteristics with predominant peaks of spring and early summer and began to be plunging at on average 3.722% per year since 2008. However, this rate reduced to 2.613% per year since 2015 and furthermore such a trend would be predicted to continue in years ahead. Conclusion The ETS framework has the ability to conduct long-term forecasting for TB incidence, which may be beneficial for the long-term planning of the TB prevention and control. Additionally, considering the predicted dropping rate of TB morbidity, more particular strategies should be formulated to dramatically accelerate progress towards the goals of the End TB Strategy.
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Affiliation(s)
- Yongbin Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, Henan, People's Republic of China
| | - Chunjie Xu
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing, People's Republic of China
| | - Jingchao Ren
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, Henan, People's Republic of China
| | - Weidong Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, Henan, People's Republic of China
| | - Xiangmei Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, Henan, People's Republic of China
| | - Ling Chao
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, Henan, People's Republic of China
| | - Wenjuan Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, Henan, People's Republic of China
| | - Sanqiao Yao
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, Henan, People's Republic of China
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Huang F, van den Hof S, Qu Y, Li Y, Zhang H, Wang L, Sun M, Lu W, Hou S, Zhang T, Huan S, Chin DP, Cobelens F. Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear-Negative Drug-Resistant Tuberculosis, China. Emerg Infect Dis 2019; 25:1289-1296. [PMID: 31211666 PMCID: PMC6590765 DOI: 10.3201/eid2507.181417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The increase in drug-resistant tuberculosis in China calls for scaling up rapid diagnosis. We evaluated introduction of rapid resistance testing by line-probe assay for all patients with a diagnosis of pulmonary tuberculosis in 2 prefectures in middle and eastern China. We analyzed sputum samples for smear-positive patients and cultures for smear-negative patients. We used a before–after comparison of baseline and intervention periods (12 months each) and analyzed data for 5,222 baseline period patients and 4,364 intervention period patients. The number of patients with rifampin resistance increased from 30 in the baseline period to 97 in the intervention period for smear-positive patients and from 0 to 13 for smear-negative patients, reflecting a low proportion of positive cultures (410/2,844, 14.4%). Expanding rapid testing for drug resistance for smear-positive patients resulted in a 3-fold increase in patients with diagnoses of rifampin-resistant tuberculosis. However, testing smear-negative patients had limited added value because of a low culture-positive rate.
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Nirgude AS, Kumar AMV, Collins T, Naik PR, Parmar M, Tao L, Akshaya KM, Raghuveer P, Yatnatti SK, Nagendra N, Nagaraja SB, Habeena S, Mn B, Rao R, Shastri S. 'I am on treatment since 5 months but I have not received any money': coverage, delays and implementation challenges of 'Direct Benefit Transfer' for tuberculosis patients - a mixed-methods study from South India. Glob Health Action 2019; 12:1633725. [PMID: 31328678 PMCID: PMC6713952 DOI: 10.1080/16549716.2019.1633725] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: In March 2018, the Government of India launched a direct benefit transfer (DBT) scheme to provide nutritional support for all tuberculosis (TB) patients in line with END TB strategy. Here, the money (@INR 500 [~8 USD] per month) is deposited electronically into the bank accounts of beneficiaries. To avail the benefit, patients are to be notified in NIKSHAY (web-based notification portal of India’s national TB programme) and provide bank account details. Once these details are entered into NIKSHAY, checked and approved by the TB programme officials, it is sent to the public financial management system (PFMS) portal for further processing and payment. Objectives: To assess the coverage and implementation barriers of DBT among TB patients notified during April–June 2018 and residing in Dakshina Kannada, a district in South India. Methods: This was a convergent mixed-methods study involving cohort analysis of patient data from NIKSHAY and thematic analysis of in-depth interviews of providers and patients. Results: Of 417 patients, 208 (49.9%) received approvals for payment by PFMS and 119 (28.7%) got paid by 1 December 2018 (censor date). Reasons for not receiving DBT included (i) not having a bank account especially among migrant labourers in urban areas, (ii) refusal to avail DBT by rich patients and those with confidentiality concerns, (iii) lack of knowledge and (iv) perception that money was too little to meet the needs. The median (IQR) delay from diagnosis to payment was 101 (67–173) days. Delays were related to the complexity of processes requiring multiple layers of approval and paper-based documentation which overburdened the staff, bulk processing once-a-month and technological challenges (poor connectivity and issues related to NIKSHAY and PFMS portals). Conclusion: DBT coverage was low and there were substantial delays. Implementation barriers need to be addressed urgently to improve uptake and efficiency. The TB programme has begun to take action.
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Affiliation(s)
- Abhay Subhashrao Nirgude
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Ajay M V Kumar
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India.,b Department of Research, International Union Against Tuberculosis and Lung Disease (The Union) , Paris , France.,c Department of Research, The Union South-East Asia Office , New Delhi , India
| | - Timire Collins
- d Center for Operations Research, International Union Against Tuberculosis and LungDisease , Harare , Zimbabwe
| | - Poonam Ramesh Naik
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Malik Parmar
- e Communicable Disease Section (Tuberculosis), WHO Country Office for India , New Delhi , India
| | - Li Tao
- f National Center for Tuberculosis Control and Prevention, China CDC , Beijing , China
| | - Kibballi Madhukeshwar Akshaya
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Pracheth Raghuveer
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Santosh K Yatnatti
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Navya Nagendra
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Sharath B Nagaraja
- g Department of Community Medicine, ESIC Medical College and PGIMSR , Bengaluru , India
| | - Shaira Habeena
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Badarudeen Mn
- h Health and Family Welfare Department , Mangaluru , India
| | - Ramkrishna Rao
- h Health and Family Welfare Department , Mangaluru , India
| | - Suresh Shastri
- i Karnataka State AIDS Prevention Society and State Tuberculosis Cell , Bangalore , Karnataka , India
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Xin YJ, Xiang L, Jiang JN, Lucas H, Tang SL, Huang F. The impact of increased reimbursement rates under the new cooperative medical scheme on the financial burden of tuberculosis patients. Infect Dis Poverty 2019; 8:67. [PMID: 31370909 PMCID: PMC6676612 DOI: 10.1186/s40249-019-0575-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) is still a major public health problem in China. To scale up TB control, an innovative programme entitled the ‘China-Gates Foundation Collaboration on TB Control in China was initiated in 2009. During the second phase of the project, a policy of increased reimbursement rates under the New Cooperative Medical Scheme (NCMS) was implemented. In this paper, we aim to explore how this reform affects the financial burden on TB patients through comparison with baseline data. Methods In two cross-sectional surveys, quantitative data were collected before (January 2010 to December 2012) and after (April 2014 to June 2015) the intervention in the existing NCMS routine data system. Information on all 313 TB inpatients, among which 117 inpatients in the project was collected. Qualitative data collection included 11 focus group discussions. Three main indicators, non-reimbursable expenses rate (NER), effective reimbursement rate (ERR), and out-of-pocket payment (OOP) as a percentage of per capita household income, were used to measure the impact of intervention by comprising post-intervention data with baseline data. The quantitative data were analysed by descriptive analysis and non-parametric tests (Mann-Whitney U test) using SPSS 22.0, and qualitative data were subjected to thematic framework analysis using Nvivo10. Results The nominal reimbursement rates for inpatient care were no less than 80% for services within the package. Total inpatient expenses greatly increased, with an average growth rate of 11.3%. For all TB inpatients, the ERR for inpatient care increased from 52 to 66%. Compared with inpatients outside the project, for inpatients covered by the new policy, the ERR was higher (78%), and OOP showed a sharper decline. In addition, their financial burden decreased significantly. Conclusions Although the nominal reimbursement rates for inpatient care of TB patients greatly increased under the new reimbursement policy, inpatient OOP expenditure was still a major financial problem for patients. Limited diagnosis and treatment options in county general hospitals and inadequate implementation of the new policy resulted in higher inpatient expenditures and limited reimbursement. Comprehensive control models are needed to effectively decrease the financial burden on all TB patients. Electronic supplementary material The online version of this article (10.1186/s40249-019-0575-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yan-Jiao Xin
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Li Xiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Jun-Nan Jiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Henry Lucas
- Institute of Development Studies, Brighton, UK
| | - Sheng-Lan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Fei Huang
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China.
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Mao W, Jiang W, Hamilton C, Zhang H, Huang F, Lucas H, Huan S, Tang S. Over- and under-treatment of TB patients in Eastern China: an analysis based on health insurance claims data. Trop Med Int Health 2019; 24:1078-1087. [PMID: 31299130 PMCID: PMC6851836 DOI: 10.1111/tmi.13287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective Poor compliance with existing guidelines for tuberculosis (TB) care and treatment is an issue of concern in China. We assessed health service use by TB patients over the entire treatment process and compared it to the recommended guidelines. Methods We collected insurance claims data in three counties of one province of Eastern China. Patient records with a diagnosis of ‘pulmonary TB’ in 2015 and 2016 were extracted. Treatment duration, number of outpatient (OP) visits and hospital admissions, as well as total cost, out‐of‐pocket (OOP) payments and effective reimbursement rates were analysed. Results A total of 1394 patients were included in the analysis. More than 48% received over the 8 months of treatment that TB guidelines recommend, and over 28% received less. 49% of Urban and Rural Resident Basic Medical Insurance (URRBMI) TB patients were hospitalised while 30% of those with Urban Employee Basic Medical Insurance (UEBMI) had at least one admission. Median total cost for patients with hospital admission was almost 10 times that of patients without. By comparison, the average OOP was 5 times higher. UEBMI patients had a shorter treatment period, more outpatient visits but considerably fewer hospital admissions than URRBMI patients. Conclusions We found an alarming extent of TB over‐ and under‐treatment in our study population. There is an urgent need to improve compliance with treatment guidelines in China and to better understand the drivers of divergence. Extending the coverage of health insurance schemes and increasing reimbursement rates for TB outpatient services would seem to be key factors in reducing both the overall cost and financial burden on patients.
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Affiliation(s)
- Wenhui Mao
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Weixi Jiang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | | | - Hui Zhang
- National Center for TB Control and Prevention, China CDC, Beijing, China
| | - Fei Huang
- National Center for TB Control and Prevention, China CDC, Beijing, China
| | - Henry Lucas
- Institute of Development Studies, Sussex University, Brighton, UK
| | | | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Global Health Research Center, Duke Kunshan University, Kunshan, China
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Okedo-Alex IN, Akamike IC, Ezeanosike OB, Uneke CJ. A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage. Int J Health Plann Manage 2019; 34:e1387-e1404. [PMID: 31311065 DOI: 10.1002/hpm.2847] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In the Nigerian context, preconditions for financial catastrophe are operational as there is high out-of-pocket spending (OOPS) on health with low capacity to pay, presence of user fees, and poor prepayment insurance coverage. We reviewed the incidence and determinants of catastrophic health expenditure (CHE) in Nigeria. METHODS Databases including PubMed, OVID, EMBASE, CINAHL, and Web of Science were searched for primary research studies on the incidence and determinants of CHE in Nigeria published between 2003 and 2018. Search terms used include household, out-of-pocket expenditure, catastrophic health expenditure, and Nigeria. RESULTS Twenty studies that met the inclusion criteria were included in the review. At 10% of total household and nonfood expenditure, the incidence of CHE was 8.2% to 50%, while 3.2% to 100% households incurred CHE at 40% of nonfood expenditure. The incidence of CHE was higher among inpatients and studies with lower threshold definitions. Outpatient CHE was highest for type 2 diabetes and tuberculosis while human immunodeficiency virus (HIV) care incurred the most CHE among inpatients. Determinants of CHE include wealth status, age, gender, place of residence/geographical location, household size/composition, educational status, health insurance status, illness, and health provider types. CONCLUSION There is a high incidence of CHE across various common health conditions in Nigeria. CHE was more among the poor, elderly, rural dwellers, private facility utilization, female gender, and noninsured among others. We recommend expansion of the National Health Insurance Scheme via informal social and financing networks platforms. Increased budgetary allocation to health and intersectoral collaboration will also play a significant role in CHE reduction.
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Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme University Teaching Hospital Abakaliki Ebonyi State Nigeria, Abakaliki, Nigeria
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme University Teaching Hospital Abakaliki Ebonyi State Nigeria, Abakaliki, Nigeria
| | - Obumneme Benaiah Ezeanosike
- Department of Paediatrics, Alex Ekwueme University Teaching Hospital Abakaliki Ebonyi State Nigeria, Abakaliki, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
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Xu CH, Jeyashree K, Shewade HD, Xia YY, Wang LX, Liu Y, Zhang H, Wang L. Inequity in catastrophic costs among tuberculosis-affected households in China. Infect Dis Poverty 2019; 8:46. [PMID: 31215476 PMCID: PMC6582572 DOI: 10.1186/s40249-019-0564-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are limited nationally representative studies globally in the post-2015 END tuberculosis (TB) era regarding wealth related inequity in the distribution of catastrophic costs due to TB care. Under the Chinese national tuberculosis programme setting, we aimed to assess extent of equity in distribution of total TB care costs (pre-treatment, treatment and overall) and costs as a proportion of annual household income (AHI), and describe and compare equity in distribution of catastrophic costs (pre-treatment, treatment and overall) across population sub-groups. METHODS Analytical cross-sectional study using data from national TB patient cost survey carried out in 22 counties from six provinces in China in 2017. Drug-susceptible pulmonary TB registered under programme, who had received at least 2 weeks of intensive phase therapy were included. Equity was depicted using concentration curves and concentration indices were compared using dominance test. RESULTS Of 1147 patients, the median cost of pre-treatment, treatment and overall care, were USD 283.5, USD 413.1 and USD 965.5, respectively. Richer quintiles incurred significantly higher pre-treatment and treatment costs compared to poorer quintiles. The distribution of costs as a proportion of AHI and catastrophic costs were significantly pro-poor overall as well as during pre-treatment and treatment phase. All the concentration curves for catastrophic costs (due to pre-treatment, treatment and overall care) stratified by region (east, middle and west), area of residence (urban, rural) and type of insurance (new rural co-operative medical system [NCMS], non-NCMS) also exhibited a pro-poor pattern with statistically significant (P < 0.01) concentration indices. The pro-poor distribution of the catastrophic costs due to TB treatment was significantly more inequitable among rural, compared to urban patients, and NCMS compared to non-NCMS beneficiaries. CONCLUSIONS There is inequity in the distribution of catastrophic costs due to TB care. Universal health coverage, social protection strategies complemented by quality TB care is vital to reduce inequitable distribution of catastrophic costs due to TB care in China.
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Affiliation(s)
- Cai-Hong Xu
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100226, China
| | - Kathiresan Jeyashree
- Velammal Medical College Hospital and Research Institute, Madurai, 625009, India
| | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, 110016, India
- International Union Against Tuberculosis and Lung Disease (The Union), 75006, Paris, France
- Karuna Trust, Bengaluru, 560041, India
| | - Yin-Yin Xia
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100226, China
| | - Li-Xia Wang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100226, China
| | - Yan Liu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100226, China.
| | - Li Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China.
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Dong D, Jiang WX, Long Q, Huang F, Zhang H, Chen JY, Xiang L, Li Q, Tang SL, Lucas H. Impact of an innovative tuberculosis financing and payment model on health service utilization by tuberculosis patients in China: do the poor fare better than the rich? Infect Dis Poverty 2019; 8:44. [PMID: 31182164 PMCID: PMC6558905 DOI: 10.1186/s40249-019-0559-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) prevalence is closely associated with poverty in China, and poor patients face more barriers to treatment. Using an insurance-based approach, the China-Gates TB program Phase II was implemented between 2012 and 2014 in three cities in China to improve access to TB care and reduce the financial burden on patients, particularly among the poor. This study aims to assess the program effects on service use, and its equity impact across different income groups. Methods Data from 788 and 775 patients at baseline and final evaluation were available for analysis respectively. Inpatient and outpatient service utilization, treatment adherence, and patient satisfaction were assessed before and after the program, across different income groups (extreme poverty, moderate poverty and non-poverty), and in various program cities, using descriptive statistics and multi-variate regression models. Key stakeholder interviews were conducted to qualitatively evaluate program implementation and impacts. Results After program implementation, the hospital admission rate increased more for the extreme poverty group (48.5 to 70.7%) and moderate poverty group (45.0 to 68.1%), compared to the non-poverty group (52.9 to 64.3%). The largest increase in the number of outpatient visits was also for the extreme poverty group (4.6 to 5.7). The proportion of patients with good medication adherence increased by 15 percentage points in the extreme poverty group and by ten percentage points in the other groups. Satisfaction rates were high in all groups. Qualitative feedback from stakeholders also suggested that increased reimbursement rates, easier reimbursement procedures, and allowance improved patients’ service utilization. Implementation of case-based payment made service provision more compliant to clinical pathways. Conclusion Patients in extreme or moderate poverty benefited more from the program compared to a non-poverty group, indicating improved equity in TB service access. The pro-poor design of the program provides important lessons to other TB programs in China and other countries to better address TB care for the poor. Electronic supplementary material The online version of this article (10.1186/s40249-019-0559-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Di Dong
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Wei-Xi Jiang
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Fei Huang
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China.
| | - Jia-Ying Chen
- School of Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Li Xiang
- Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiang Li
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Sheng-Lan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Henry Lucas
- Institute of Development Studies, University of Sussex, Brighton, UK
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Duan W, Zhang W, Wu C, Wang Q, Yu Y, Lin H, Liu Y, Hu D. Extent and determinants of catastrophic health expenditure for tuberculosis care in Chongqing municipality, China: a cross-sectional study. BMJ Open 2019; 9:e026638. [PMID: 30975682 PMCID: PMC6500361 DOI: 10.1136/bmjopen-2018-026638] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the extent and associations of patient/diagnostic delay and other potential factors with catastrophic health expenditure (CHE) for tuberculosis (TB) care in Chongqing municipality, China. DESIGN A cross-sectional study. SETTING Four counties of Chongqing municipality, China. PARTICIPANTS A total of 1199 patients with active pulmonary TB beyond 16 years and without mental disorders were consecutively recruited in the four counties' designated TB medical institutions. OUTCOME MEASURES The incidence and intensity of CHE for TB care were described. The association between patients' 'sociodemographic and clinical characteristics such as patient delay, diagnostic delay, forms of TB, health insurance status and hospitalisation and CHE were analysed using univariate and multivariate logistic regression. RESULTS The incidence of CHE was 52.8% and out-of-pocket (OOP) payments were 93% of the total costs for TB care. Compared with patients without delay, the incidence and intensity of CHE were higher in patients who had patient delay or diagnostic delay. Patients who experienced patient delay or diagnostic delay, who was a male, elderly (≥60 years), an inhabitant, a peasant, divorced/widow, the New Cooperative Medical Scheme membership had greater risks of incurring CHE for TB care. Having a higher educational level appeared to be a protective factor. However, hospitalisation was not associated with CHE after controlling for other variables. CONCLUSION The incidence and intensity of CHE for TB care are high, which provides baseline data about catastrophic costs that TB-related households faced in Chongqing of China. Variety of determinants of CHE implicate that it is essential to take effective measures to promote early seeking care and early diagnosis, improve the actual reimbursement rates of health insurance, especially for outpatients, and need more fine-tuned interventions such as precise poverty alleviation to reduce catastrophic costs of the vulnerable population.
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Affiliation(s)
- Weixia Duan
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
- The center of Laboratory Medicine, Chongqing Occupational Diseases Prevention Hospital, Chongqing, China
| | - Wen Zhang
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
| | - Chengguo Wu
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
| | - Qingya Wang
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
| | - Ya Yu
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
| | - Hui Lin
- Department of Epidemiology, The Third Military Medical University, Chongqing, China
| | - Ying Liu
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
| | - Daiyu Hu
- Department of Prevention, Chongqing Institute of Tuberculosis Prevention and Treatment, Chongqing, China
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Jiang WX, Long Q, Lucas H, Dong D, Chen JY, Xiang L, Li Q, Huang F, Wang H, Elbers C, Cobelens F, Tang SL. Impact of an innovative financing and payment model on tuberculosis patients' financial burden: is tuberculosis care more affordable for the poor? Infect Dis Poverty 2019; 8:21. [PMID: 30904025 PMCID: PMC6431427 DOI: 10.1186/s40249-019-0532-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 03/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In response to the high financial burden of health services facing tuberculosis (TB) patients in China, the China-Gates TB project, Phase II, has implemented a new financing and payment model as an important component of the overall project in three cities in eastern, central and western China. The model focuses on increasing the reimbursement rate for TB patients and reforming provider payment methods by replacing fee-for-service with a case-based payment approach. This study investigated changes in out-of-pocket (OOP) health expenditure and the financial burden on TB patients before and after the interventions, with a focus on potential differential impacts on patients from different income groups. METHODS Three sample counties in each of the three prefectures: Zhenjiang, Yichang and Hanzhong were chosen as study sites. TB patients who started and completed treatment before, and during the intervention period, were randomly sampled and surveyed at the baseline in 2013 and final evaluation in 2015 respectively. OOP health expenditure and percentage of patients incurring catastrophic health expenditure (CHE) were calculated for different income groups. OLS regression and logit regression were conducted to explore the intervention's impacts on patient OOP health expenditure and financial burden after adjusting for other covariates. Key-informant interviews and focus group discussions were conducted to understand the reasons for any observed changes. RESULTS Data from 738 (baseline) and 735 (evaluation) patients were available for analysis. Patient mean OOP health expenditure increased from RMB 3576 to RMB 5791, and the percentage of patients incurring CHE also increased after intervention. The percentage increase in OOP health expenditure and the likelihood of incurring CHE were significantly lower for patients from the highest income group as compared to the lowest. Qualitative findings indicated that increased use of health services not covered by the standard package of the model was likely to have caused the increase in financial burden. CONCLUSIONS The implementation of the new financing and payment model did not protect patients, especially those from the lowest income group, from financial difficulty, due partly to their increased use of health service. More financial resources should be mobilized to increase financial protection, particularly for poor patients, while cost containment strategies need to be developed and effectively implemented to improve the effective coverage of essential healthcare in China.
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Affiliation(s)
- Wei-Xi Jiang
- Global Health Research Center, Duke Kunshan University, Kunshan, 215316, Jiangsu, China
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, 215316, Jiangsu, China
| | - Henry Lucas
- Institute of Development Studies, University of Sussex, Brighton, BN1 9RE, UK
| | - Di Dong
- Global Health Research Center, Duke Kunshan University, Kunshan, 215316, Jiangsu, China
| | - Jia-Ying Chen
- School of Policy & Management, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Li Xiang
- Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Qiang Li
- School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Fei Huang
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, 102206, China
| | - Hong Wang
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Chris Elbers
- Faculty of Economics and Business Administration, Vrije Universiteit Amsterdam, Amsterdam, 1081, HV, the Netherlands
| | - Frank Cobelens
- The Amsterdam Institute for Global Health and Development, Amsterdam, 1105, BP, the Netherlands
| | - Sheng-Lan Tang
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA.
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Jing Z, Chu J, Imam Syeda Z, Zhang X, Xu Q, Sun L, Zhou C. Catastrophic health expenditure among type 2 diabetes mellitus patients: A province-wide study in Shandong, China. J Diabetes Investig 2019; 10:283-289. [PMID: 30044060 PMCID: PMC6400173 DOI: 10.1111/jdi.12901] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/10/2018] [Accepted: 07/21/2018] [Indexed: 11/27/2022] Open
Abstract
AIMS/INTRODUCTION Diabetes mellitus often causes high economic burden on the patients and their households. The present study aimed to assess the incidence and intensity of catastrophic health expenditure (CHE) relating to type 2 diabetes mellitus care, and to explore its determinants in China. MATERIALS AND METHODS A total of 1,948 type 2 diabetes patients were included in the analysis. CHE for type 2 diabetes mellitus was defined as out-of-pocket payments for diabetes care that were ≥40% of the non-food expenditure of a household. The Chi-square-test was used to identify the factors associated with CHE. Multivariate logistic regression was used to assess the effects of explanatory analysis variables. RESULTS The incidence of CHE for type 2 diabetes mellitus care was 13.8%. An association was observed between CHE incidence and household income level, and the poorest group was more likely to experience CHE as a result of diabetes mellitus care. The type 2 diabetes mellitus patients with complications were found to be more likely to experience CHE. Diabetes patients who experienced outpatient or inpatient services increased the likelihood of CHE, and those who experienced inpatient services were more likely to incur CHE. CONCLUSIONS Type 2 diabetes mellitus has a significantly catastrophic effect on patients and their households in China. Early screening for type 2 diabetes mellitus patients among the high-risk groups and effective management of the detected cases should be priorities to reduce the overall healthcare expenditure for type 2 diabetes mellitus.
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Affiliation(s)
- Zhengyue Jing
- School of PublicHealth Shandong UniversityJinanChina
| | - Jie Chu
- Shandong Centre for Disease Control and PreventionJinanChina
| | | | - Xinyi Zhang
- School of PublicHealth Shandong UniversityJinanChina
| | - Qiongqiong Xu
- School of PublicHealth Shandong UniversityJinanChina
| | - Long Sun
- School of PublicHealth Shandong UniversityJinanChina
- Key Lab of Health Economics and Policy ResearchShandong UniversityJinanChina
| | - Chengchao Zhou
- School of PublicHealth Shandong UniversityJinanChina
- Key Lab of Health Economics and Policy ResearchShandong UniversityJinanChina
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Sakamoto H, Lee S, Ishizuka A, Hinoshita E, Hori H, Ishibashi N, Komada K, Norizuki M, Katsuma Y, Akashi H, Shibuya K. Challenges and opportunities for eliminating tuberculosis - leveraging political momentum of the UN high-level meeting on tuberculosis. BMC Public Health 2019; 19:76. [PMID: 30651096 PMCID: PMC6335677 DOI: 10.1186/s12889-019-6399-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background As demonstrated by the United Nations High-Level Meeting on tuberculosis (TB) held in September 2018, the political momentum for TB has been increasing. The aim of this study was to analyze the current challenges and opportunities for global TB control and, with specific focus on policies surrounding TB control, to reveal what kinds of efforts are needed to accelerate global TB control. Methods We organized two expert meetings with the purposes of assessing the current situation and analyzing challenges regarding TB control. By applying Shiffman and Smith’s framework which contains four categories; Actor, Ideas, Political context, and Issue characteristics, we analyzed the challenges and opportunities for global TB control based on the findings from the two expert meetings. Results In the Actor Category, we found that although there has already been active engagement by non-governmental organizations (NGOs), civil society organizations (CSOs) and private sectors, there still remained an area with room for improvement. In particular, the complexities behind varying drug regulatory and procurement systems per country hindered the active participation of the private sector in this area. As for the Ideas category, due to an increasing threat of antimicrobial resistance and growing number of global migrations, TB is now widely recognized as a health security issue rather than a purely health issue. This makes TB an easier target for political attention. As for the Political category, having the UN High-Level Meeting itself is not enough; such meetings must be followed up by actual commitments from heads of states. Lastly the issue characteristic indicates that the amount of funding for R&D for new drugs, vaccines and diagnostics for TB is not at an adequate level, and investment in childhood TB and missing cases are particularly in need. Conclusions This study provides important insight into the current status of global efforts toward end TB epidemic. The outcomes from the UN high-level meeting on TB need to be closely monitored will be crucial for the progress towards this goal.
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Affiliation(s)
- Haruka Sakamoto
- Department of Global Health Policy, Graduate School of Medicine, Medical Building No.3, Hongo Campus, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Sangnim Lee
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Institute for Global Health Policy Research, Tokyo, Japan
| | - Aya Ishizuka
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Institute for Global Health Policy Research, Tokyo, Japan.,School of Global Studies and Collaboration, Aoyama Gakuin University, Kanagawa, Japan
| | - Eiji Hinoshita
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Hori
- Ministry of Health, Labour and Welfare of Japan, Tokyo, Japan
| | - Nanao Ishibashi
- Ministry of Health, Labour and Welfare of Japan, Tokyo, Japan
| | - Kenichi Komada
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masataro Norizuki
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasushi Katsuma
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Institute for Global Health Policy Research, Tokyo, Japan.,Graduate School of Asia-Pacific Studies, Waseda University, Tokyo, Japan
| | - Hidechika Akashi
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, Medical Building No.3, Hongo Campus, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.,Bureau of International Health Cooperation, National Center for Global Health and Medicine, Institute for Global Health Policy Research, Tokyo, Japan
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Prasanna T, Jeyashree K, Chinnakali P, Bahurupi Y, Vasudevan K, Das M. Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India. Glob Health Action 2018; 11:1477493. [PMID: 29902134 PMCID: PMC6008578 DOI: 10.1080/16549716.2018.1477493] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from $55 to $8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016–2035) is that no TB-affected household suffers catastrophic costs due to TB. Study setting was free care under national tuberculosis program (NTP), Puducherry district, India. Objectives: The objectives of the study were among the newly diagnosed and previously treated tuberculosis (TB) patients, to (a) estimate patient costs during diagnosis and intensive phase of treatment, (b) determine the proportion of households experiencing catastrophic costs, and (c) explore coping strategies. Methods: An explanatory mixed methods design comprising both quantitative cost description and qualitative descriptive component was used. Catastrophic cost was defined as total TB care costs exceeding 20% of annual household income. Results: Of 102 TB patients included, two-thirds (69%) were male, 6% were HIV positive, and 45% reported at least one episode of hospitalization for TB care. The median (IQR) total cost of TB care was US$195 (52.1, 492.9) with a direct cost of US$65.3 (22.3, 156.5) and indirect cost of US$50.2 (0.9, 295.1). Overall, 32.4% of households experienced catastrophic costs due to TB care, significantly higher in patients with HIV coinfection (p = 0.009) and hospitalization (p = 0.009). Pledging jewels and borrowing money were major coping strategies. Cash assistance was the expected remedy from the patient perspective. Conclusion: Despite free TB care under NTP, more than a third incurred catastrophic costs towards TB care.
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Affiliation(s)
- Thirunavukkarasu Prasanna
- a Department of Community Medicine and Family Medicine , All India Institute of Medical Sciences , Jodhpur , India.,b Department of Community Medicine , Indira Gandhi Medical College and Research Institute, Govt. of Puducherry Institution , Puducherry , India
| | - Kathiresan Jeyashree
- c Department of Community Medicine , Velammal Medical College Hospital and Research Institute , Madurai , India
| | - Palanivel Chinnakali
- d Department of Preventive and Social Medicine , Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry , India
| | - Yogesh Bahurupi
- b Department of Community Medicine , Indira Gandhi Medical College and Research Institute, Govt. of Puducherry Institution , Puducherry , India
| | - Kavita Vasudevan
- b Department of Community Medicine , Indira Gandhi Medical College and Research Institute, Govt. of Puducherry Institution , Puducherry , India
| | - Mrinalini Das
- e Médecins Sans Frontières (MSF)/Doctors Without Borders , New Delhi , India
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Roba AA, Dasa TT, Weldegebreal F, Asfaw A, Mitiku H, Teklemariam Z, Naganuri M, Geddugol BJ, Mesfin F, Befikadu H, Tesfaye E. Tuberculosis patients are physically challenged and socially isolated: A mixed methods case-control study of Health Related Quality of Life in Eastern Ethiopia. PLoS One 2018; 13:e0204697. [PMID: 30321189 PMCID: PMC6188627 DOI: 10.1371/journal.pone.0204697] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/12/2018] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Pulmonary tuberculosis (TB) impairs respiratory physiology and functional ability, resulting in economic and social dependence upon others. Patients with tuberculosis especially multi drug resistant (MDR-TB) suffer from social isolation, stigma, lack of support and economic constraints. In Ethiopia, the trend of MDR TB is increasing and becoming a serious public health problem. However, little is known about patients except treatment outcomes, financial burden and psychological distress with serious deficiency of data on Health Related Quality of Life (HRQOL). Hence, the aim of this study was to assess HRQOL of MDR TB patients in comparison with drug sensitive pulmonary TB (DSTB) patients. METHODS We included 100 cases of MDR and 300 controls with DSTB who were matched by sex. Data were collected using SF- 36v2 TM questionnaire and analysed with SPSS version 20. Independent t-test and conditional logistic regression analysis was done considering P-values of less than 0.05 statistically significant. Eight in-depth interviews were also conducted with both groups and represented with verbatim quotations and narrative texts. RESULTS There were no statistically significant differences in mean scores for health related quality of life between cases and controls (57.61±16.42 and 59.13±22.10) nor were there significant differences in physical functioning, role disruption due to physical problems, vitality, social functioning, role disruption due to emotional distress, or overall mental health. Individuals with MDR-TB were significantly more likely to be single, a current student, and with lower education and families with more than 5 people than individuals with Drug sensitive TB, all of which were significantly associated with poorer HRQOL (p<0.05). There was good internal consistency of the scale scores, with a Cronbach's alpha value of 0.73. CONCLUSION Individuals with MDR-TB reported statistically worse general health but less bodily pain than individuals with Drug sensitive TB. To regain the role function they lost, we recommend that health facilities, media and all other stakeholders educate the community, households and students about pulmonary tuberculosis, treatment, prevention methods and therapeutic approaches towards TB patients, specifically MDR-TB.
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Affiliation(s)
- Aklilu Abrham Roba
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | | | - Fitsum Weldegebreal
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Abyot Asfaw
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Habtamu Mitiku
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Zelalem Teklemariam
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Mahantash Naganuri
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | | | - Frehiwot Mesfin
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Hilina Befikadu
- Haramaya University, College of Social Sciences and Humanities, Dire Dawa, Ethiopia
| | - Eden Tesfaye
- Haramaya University, College of Natural and Computational Sciences, Dire Dawa, Ethiopia
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Chen M, Qian D, Feng Z, Si L. Is outpatient care benefit distribution of government healthcare subsidies equitable in rural ethnic minority areas of China? Results from cross-sectional studies in 2010 and 2013. BMJ Open 2018; 8:e019564. [PMID: 29431138 PMCID: PMC5829884 DOI: 10.1136/bmjopen-2017-019564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Government healthcare subsidies for healthcare facilities play a significant role in providing more extensive healthcare access to patients, especially poor ones. However, equitable distribution of these subsidies continues to pose a challenge in rural ethnic minority areas of China. This study aimed to evaluate the benefits distribution of outpatient services across different socioeconomic populations in China's rural ethnic minority areas. SETTING Inner Mongolia Autonomous Region, Xinjiang Autonomous Region and Qinghai Province. DESIGN Two rounds of cross-sectional study. PARTICIPANTS One thousand and seventy patients in 2010 and 907 patients in 2013, who sought outpatient services prior to completing the household surveys, were interviewed. METHODS Benefits incidence analysis was performed to measure the benefits distribution of government healthcare subsidies across socioeconomic groups. The concentration index (CI) for outpatient care at different healthcare facility levels in rural ethnic minority areas was calculated. Two rounds of household surveys using multistage stratified samples were conducted. FINDINGS The overall CI for outpatient care was -0.0146 (P>0.05) in 2010 and -0.0992 (P<0.01) in 2013. In 2010, the CI was -0.0537 (P<0.01), -0.0085 (P>0.05) and -0.0034 (P>0.05) at levels of village clinics (VCs), township health centres (THCs) and county hospitals (CHs), respectively. In 2013, the CI was -0.1353 (P<0.05), -0.0695 (P>0.05) and -0.1633 (P<0.01) at the levels of VCs, THCs and CHs, respectively. CONCLUSION Implementation of the gatekeeper mechanism helped improve the benefits distribution of government healthcare subsidies in rural Chinese ethnic minority areas. Equitable distribution of government healthcare subsidies for VCs was improved by increasing financial input and ensuring the performance of primary healthcare facilities. Equitable distribution of subsidies for CHs was improved by policies that rationally guided patients' care-seeking behaviour. In addition, highly qualified physicians were also a key factor in ensuring equitable benefits distribution.
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Affiliation(s)
- Mingsheng Chen
- Department of Public Administration, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Institute of Healthy Jiangsu Construction and Development, Nanjing, China
| | - Dongfu Qian
- Department of Public Administration, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Institute of Healthy Jiangsu Construction and Development, Nanjing, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Si
- Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
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Fuady A, Houweling TAJ, Mansyur M, Richardus JH. Catastrophic total costs in tuberculosis-affected households and their determinants since Indonesia's implementation of universal health coverage. Infect Dis Poverty 2018; 7:3. [PMID: 29325589 PMCID: PMC5765643 DOI: 10.1186/s40249-017-0382-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 12/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background As well as imposing an economic burden on affected households, the high costs related to tuberculosis (TB) can create access and adherence barriers. This highlights the particular urgency of achieving one of the End TB Strategy’s targets: that no TB-affected households have to face catastrophic costs by 2020. In Indonesia, as elsewhere, there is also an emerging need to provide social protection by implementing universal health coverage (UHC). We therefore assessed the incidence of catastrophic total costs due to TB, and their determinants since the implementation of UHC. Methods We interviewed adult TB and multidrug-resistant TB (MDR-TB) patients in urban, suburban and rural areas of Indonesia who had been treated for at least one month or had finished treatment no more than one month earlier. Following the WHO recommendation, we assessed the incidence of catastrophic total costs due to TB. We also analyzed the sensitivity of incidence relative to several thresholds, and measured differences between poor and non-poor households in the incidence of catastrophic costs. Generalized linear mixed-model analysis was used to identify determinants of the catastrophic total costs. Results We analyzed 282 TB and 64 MDR-TB patients. For TB-related services, the median (interquartile range) of total costs incurred by households was 133 USD (55–576); for MDR-TB-related services, it was 2804 USD (1008–4325). The incidence of catastrophic total costs in all TB-affected households was 36% (43% in poor households and 25% in non-poor households). For MDR-TB-affected households, the incidence was 83% (83% and 83%). In TB-affected households, the determinants of catastrophic total costs were poor households (adjusted odds ratio [aOR] = 3.7, 95% confidence interval [CI]: 1.7–7.8); being a breadwinner (aOR = 2.9, 95% CI: 1.3–6.6); job loss (aOR = 21.2; 95% CI: 8.3–53.9); and previous TB treatment (aOR = 2.9; 95% CI: 1.4–6.1). In MDR-TB-affected households, having an income-earning job before diagnosis was the only determinant of catastrophic total costs (aOR = 8.7; 95% CI: 1.8–41.7). Conclusions Despite the implementation of UHC, TB-affected households still risk catastrophic total costs and further impoverishment. As well as ensuring access to healthcare, a cost-mitigation policy and additional financial protection should be provided to protect the poor and relieve income losses. Electronic supplementary material The online version of this article (10.1186/s40249-017-0382-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ahmad Fuady
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands. .,Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | - Tanja A J Houweling
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands
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Shewade HD, Gupta V, Satyanarayana S, Kharate A, Sahai K, Murali L, Kamble S, Deshpande M, Kumar N, Kumar S, Pandey P, Bajpai U, Tripathy JP, Kathirvel S, Pandurangan S, Mohanty S, Ghule VH, Sagili KD, Prasad BM, Nath S, Singh P, Singh K, Singh R, Jayaraman G, Rajeswaran P, Srivastava BK, Biswas M, Mallick G, Bera OP, Jaisingh AJJ, Naqvi AJ, Verma P, Ansari MS, Mishra PC, Sumesh G, Barik S, Mathew V, Lohar MRS, Gaurkhede CS, Parate G, Bale SY, Koli I, Bharadwaj AK, Venkatraman G, Sathiyanarayanan K, Lal J, Sharma AK, Rao R, Kumar AM, Chadha SS. Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis. Glob Health Action 2018; 11:1494897. [PMID: 30173603 PMCID: PMC6129780 DOI: 10.1080/16549716.2018.1494897] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/25/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. OBJECTIVES To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). METHODS In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as 'catastrophic' if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. RESULTS When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US$ 4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF [-0.15 (-0.32, 0.11)] and PCF [-0.06 (-0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [-0.60 (-0.81, -0.39)] and PCF [-0.58 (-0.78, -0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles. CONCLUSION ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity.
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Affiliation(s)
- Hemant Deepak Shewade
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Vivek Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Atul Kharate
- State TB Cell, Department of Health & Family Welfare, Government of Madhya Pradesh, Bhopal, India
| | - K.N. Sahai
- State TB Cell, Department of Health & Family Welfare, Government of Bihar, Patna, India
| | - Lakshmi Murali
- State TB Cell, Department of Health & Family Welfare, Government of Tamil Nadu, Chennai, India
| | - Sanjeev Kamble
- State TB Cell, Health Department, Government of Maharashtra, Pune, India
| | - Madhav Deshpande
- State TB Cell, Department of Health & Family Welfare, Government of Chattisgarh, Raipur, India
| | - Naresh Kumar
- State TB Cell, Department of Health & Family Welfare, Government of Punjab, Chandigarh, India
| | - Sunil Kumar
- State TB Cell, Department of Health & Family Welfare, Government of Kerala, Thiruvananthapuram, India
| | - Prabhat Pandey
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - U.N. Bajpai
- Voluntary Health Association of India (VHAI), New Delhi, India
| | - Jaya Prasad Tripathy
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Soundappan Kathirvel
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sripriya Pandurangan
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Subrat Mohanty
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Vaibhav Haribhau Ghule
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Karuna D. Sagili
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Banuru Muralidhara Prasad
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Sudhi Nath
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Priyanka Singh
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Kamlesh Singh
- Catholic Health Association of India (CHAI), Telangana, India
| | - Ramesh Singh
- Voluntary Health Association of India (VHAI), New Delhi, India
| | - Gurukartick Jayaraman
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - P. Rajeswaran
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | | | - Moumita Biswas
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Gayadhar Mallick
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Om Prakash Bera
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | | | - Ali Jafar Naqvi
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Prafulla Verma
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | | | - Prafulla C. Mishra
- Catholic Bishops’ Conference of India-Coalition for AIDS and Related Diseases (CBCI-CARD), New Delhi, India
| | - G. Sumesh
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - Sanjeeb Barik
- Emmanuel Hospital Association (EHA), New Delhi, India
| | - Vijesh Mathew
- Catholic Health Association of India (CHAI), Telangana, India
| | | | | | - Ganesh Parate
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | | | - Ishwar Koli
- Catholic Health Association of India (CHAI), Telangana, India
| | | | - G. Venkatraman
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - K. Sathiyanarayanan
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - Jinesh Lal
- Catholic Health Association of India (CHAI), Telangana, India
| | | | - Raghuram Rao
- Central TB Division, Revised National Tuberculosis Control Programme, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Ajay M.V. Kumar
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Sarabjit Singh Chadha
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
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Estimated clinical impact of the Xpert MTB/RIF Ultra cartridge for diagnosis of pulmonary tuberculosis: A modeling study. PLoS Med 2017; 14:e1002472. [PMID: 29240766 PMCID: PMC5730108 DOI: 10.1371/journal.pmed.1002472] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 11/14/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Xpert MTB/RIF (Xpert) assay offers rapid and accurate diagnosis of tuberculosis (TB) but still suffers from imperfect sensitivity. The newer Xpert MTB/RIF Ultra cartridge has shown improved sensitivity in recent field trials, but at the expense of reduced specificity. The clinical implications of switching from the existing Xpert cartridge to the Xpert Ultra cartridge in different populations remain uncertain. METHODS AND FINDINGS We developed a Markov microsimulation model of hypothetical cohorts of 100,000 individuals undergoing diagnostic sputum evaluation with Xpert for suspected pulmonary TB, in each of 3 emblematic settings: an HIV clinic in South Africa, a public TB center in India, and an adult primary care setting in China. In each setting, we used existing data to project likely diagnostic results, treatment decisions, and ultimate clinical outcomes, assuming use of the standard Xpert versus Xpert Ultra cartridge. Our primary outcomes were the projected number of additional unnecessary treatments generated, the projected number of TB deaths averted, and the projected number of unnecessary treatments generated per TB death averted, if standard Xpert were switched to Xpert Ultra. We also simulated alternative approaches to interpreting positive results of the Ultra cartridge's semi-quantitative trace call. Extensive sensitivity and uncertainty analyses were performed to evaluate the drivers and generalizability of projected results. In the Indian TB center setting, replacing the standard Xpert cartridge with the Xpert Ultra cartridge was projected to avert 0.5 TB deaths (95% uncertainty range [UR]: 0, 1.3) and generate 18 unnecessary treatments (95% UR: 10, 29) per 1,000 individuals evaluated-resulting in a median ratio of 38 incremental unnecessary treatments added by Ultra per incremental death averted by Ultra compared to outcomes using standard Xpert (95% UR: 12, indefinite upper bound). In the South African HIV care setting-where TB mortality rates are higher and Ultra's improved sensitivity has greater absolute benefit-this ratio improved to 7 unnecessary treatments per TB death averted (95% UR: 2, 43). By contrast, in the Chinese primary care setting, this ratio was much less favorable, at 372 unnecessary treatments per TB death averted (95% UR: 75, indefinite upper bound), although the projected number of unnecessary treatments using Xpert Ultra was lower (with a possibility of no increased overtreatment) when using specificity data only from lower-burden settings. Alternative interpretations of the trace call had little effect on these ratios. Limitations include uncertainty in key parameters (including the clinical implications of false-negative results), the exclusion of transmission effects, and restriction of this analysis to adult pulmonary TB. CONCLUSIONS Switching from the standard Xpert cartridge to the Xpert Ultra cartridge for diagnosis of adult pulmonary TB may have different consequences in different clinical settings. In settings with high TB and HIV prevalence, Xpert Ultra is likely to offer considerable mortality benefit, whereas in lower-prevalence settings, Xpert Ultra will likely result in considerable overtreatment unless the possibility of higher specificity of Ultra in lower-prevalence settings in confirmed. The ideal use of the Ultra cartridge may therefore involve a more nuanced, setting-specific approach to implementation, with priority given to populations in which the anticipated prevalence of TB (and HIV) is the highest.
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Datiko DG, Yassin MA, Theobald SJ, Blok L, Suvanand S, Creswell J, Cuevas LE. Health extension workers improve tuberculosis case finding and treatment outcome in Ethiopia: a large-scale implementation study. BMJ Glob Health 2017; 2:e000390. [PMID: 29209537 PMCID: PMC5704104 DOI: 10.1136/bmjgh-2017-000390] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/14/2017] [Accepted: 10/06/2017] [Indexed: 11/26/2022] Open
Abstract
Background Tuberculosis (TB) is a major cause of death in Ethiopia. One of the main barriers for TB control is the lack of access to health services. Methods We evaluated a diagnostic and treatment service for TB based on the health extension workers (HEW) of the Ethiopian Health Extension Programme in Sidama Zone, with 3.5 million population. We added the services to the HEW routines and evaluated their effect over 4.5 years. 1024 HEWs were trained to identify individuals with symptoms of TB, request sputum samples and prepare smears. Smears were transported to designated laboratories. Individuals with TB were offered treatment at home or the local health post. A second zone (Hadiya) with 1.2 million population was selected as control. We compared TB case notification rates (CNR) and treatment outcomes in the zones 3 years before and 4.5 years after intervention. Results HEWs identified 216 165 individuals with symptoms and 27 918 (12%) were diagnosed with TB. Smear-positive TB CNR increased from 64 (95% CI 62.5 to 65.8) to 127 (95% CI 123.8 to 131.2) and all forms of TB increased from 102 (95% CI 99.1 to 105.8) to 177 (95% CI 172.6 to 181.0) per 100 000 population in the first year of intervention. In subsequent years, the smear-positive CNR declined by 9% per year. There was no change in CNR in the control area. Treatment success increased from 76% before the intervention to 95% during the intervention. Patients lost to follow-up decreased from 21% to 3% (p<0.001). Conclusion A community-based package significantly increased case finding and improved treatment outcome. Implementing this strategy could help meet the Ethiopian Sustainable Development Goal targets.
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Affiliation(s)
| | - Mohammed A Yassin
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Sally J Theobald
- Faculty of Clinical Sciences and International Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lucie Blok
- Royal Tropical Institute (KIT), Amsterdam, The Netherlands
| | | | | | - Luis E Cuevas
- Faculty of Clinical Sciences and International Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Rudgard WE, Evans CA, Sweeney S, Wingfield T, Lönnroth K, Barreira D, Boccia D. Comparison of two cash transfer strategies to prevent catastrophic costs for poor tuberculosis-affected households in low- and middle-income countries: An economic modelling study. PLoS Med 2017; 14:e1002418. [PMID: 29112693 PMCID: PMC5675360 DOI: 10.1371/journal.pmed.1002418] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 09/29/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Illness-related costs for patients with tuberculosis (TB) ≥20% of pre-illness annual household income predict adverse treatment outcomes and have been termed "catastrophic." Social protection initiatives, including cash transfers, are endorsed to help prevent catastrophic costs. With this aim, cash transfers may either be provided to defray TB-related costs of households with a confirmed TB diagnosis (termed a "TB-specific" approach); or to increase income of households with high TB risk to strengthen their economic resilience (termed a "TB-sensitive" approach). The impact of cash transfers provided with each of these approaches might vary. We undertook an economic modelling study from the patient perspective to compare the potential of these 2 cash transfer approaches to prevent catastrophic costs. METHODS AND FINDINGS Model inputs for 7 low- and middle-income countries (Brazil, Colombia, Ecuador, Ghana, Mexico, Tanzania, and Yemen) were retrieved by literature review and included countries' mean patient TB-related costs, mean household income, mean cash transfers, and estimated TB-specific and TB-sensitive target populations. Analyses were completed for drug-susceptible (DS) TB-related costs in all 7 out of 7 countries, and additionally for drug-resistant (DR) TB-related costs in 1 of the 7 countries with available data. All cost data were reported in 2013 international dollars ($). The target population for TB-specific cash transfers was poor households with a confirmed TB diagnosis, and for TB-sensitive cash transfers was poor households already targeted by countries' established poverty-reduction cash transfer programme. Cash transfers offered in countries, unrelated to TB, ranged from $217 to $1,091/year/household. Before cash transfers, DS TB-related costs were catastrophic in 6 out of 7 countries. If cash transfers were provided with a TB-specific approach, alone they would be insufficient to prevent DS TB catastrophic costs in 4 out of 6 countries, and when increased enough to prevent DS TB catastrophic costs would require a budget between $3.8 million (95% CI: $3.8 million-$3.8 million) and $75 million (95% CI: $50 million-$100 million) per country. If instead cash transfers were provided with a TB-sensitive approach, alone they would be insufficient to prevent DS TB-related catastrophic costs in any of the 6 countries, and when increased enough to prevent DS TB catastrophic costs would require a budget between $298 million (95% CI: $219 million-$378 million) and $165,367 million (95% CI: $134,085 million-$196,425 million) per country. DR TB-related costs were catastrophic before and after TB-specific or TB-sensitive cash transfers in 1 out of 1 countries. Sensitivity analyses showed our findings to be robust to imputation of missing TB-related cost components, and use of 10% or 30% instead of 20% as the threshold for measuring catastrophic costs. Key limitations were using national average data and not considering other health and social benefits of cash transfers. CONCLUSIONS A TB-sensitive cash transfer approach to increase all poor households' income may have broad benefits by reducing poverty, but is unlikely to be as effective or affordable for preventing TB catastrophic costs as a TB-specific cash transfer approach to defray TB-related costs only in poor households with a confirmed TB diagnosis. Preventing DR TB-related catastrophic costs will require considerable additional investment whether a TB-sensitive or a TB-specific cash transfer approach is used.
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Affiliation(s)
- William E. Rudgard
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- * E-mail:
| | - Carlton A. Evans
- Innovation For Health And Development (IFHAD), Section of Infectious Diseases & Immunity, Imperial College London and Wellcome Trust Imperial College Centre for Global Health Research, London, United Kingdom
- Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Perú
- Innovation For Health And Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Sedona Sweeney
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Tom Wingfield
- Infectious Diseases & Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, United Kingdom
- Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospital, Liverpool, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Knut Lönnroth
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Draurio Barreira
- National TB Control Program (NTP), Secretariat of Health Surveillance, Ministry of Health of Brazil, Brasília DF, Brazil
| | - Delia Boccia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
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Paiva BL, Azeredo JQ, Nogueira LMV, Santos BDO, Rodrigues ILA, Santos MNDA. Spatial distribution of tuberculosis in indigenous and non-indigenous populations in the state of Pará, Brazil, 2005-2013. ESCOLA ANNA NERY 2017. [DOI: 10.1590/2177-9465-ean-2017-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To analyze the incidence of tuberculosis in indigenous and non-indigenous residents in the state of Pará from 2005-2013. Method: An ecological study was performed with data from SINAN, stratified for the 13 existing Regional Health Centers in Pará. The tuberculosis incidence rates were calculated for indigenous and non-indigenous populations in the 13 regions and maps were prepared to visualize the magnitude of the occurrence of tuberculosis. Results: Significant differences in the incidence of tuberculosis were found among non-indigenous and indigenous populations, reaching 7,812/100,000 inhabitants and 118/100,000 inhabitants respectively. Conclusion: Tuberculosis was distributed heterogeneously among the indigenous and non-indigenous populations. Moreover, it was possible to identify areas with high risk for this disease. It is important to note that knowledge about priority areas for tuberculosis control can help health service management to improve indicators that assess this disease and to develop different policies for indigenous peoples.
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Getahun B, Wubie M, Dejenu G, Manyazewal T. Tuberculosis care strategies and their economic consequences for patients: the missing link to end tuberculosis. Infect Dis Poverty 2016; 5:93. [PMID: 27799063 PMCID: PMC5088676 DOI: 10.1186/s40249-016-0187-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While investment in the development of Tuberculosis (TB) treatment strategies is essential, it cannot be assumed that the strategies are affordable for TB patients living in countries with high economic constraints. This study aimed to determine the economic consequences of directly observed therapy for TB patients. METHODS A cross-sectional cost-of-illness analysis was conducted between September to November 2015 among 576 randomly selected adult TB patients who were on directly observed treatment in 27 public health facilities in Addis Ababa, Ethiopia. Data were collected using interviewer-administered questionnaire adapted from the Tool to Estimate Patients' Costs. Mean and median costs, reduction of productivity, and household expenditure of TB patients were calculated and ways of coping costs captured. Eta (η), Odds ratio and p values were used to measure association between variables. RESULTS Of the total 576 TB patients enrolled, 43 % were smear-positive pulmonary TB (PTB), 17 % smear-negative PTB, 37 % Extra-PTB and 3 % multi-drug resistant TB cases. Direct (Out-of-Pocket) mean and median costs of TB illness to patients were $123.0 (SD = 58.8) and $125.78 (R = 338.12), respectively, and indirect (loss income) mean and median costs were $54.26 (SD = 43.5) and $44.61 (R = 215.6), respectively. Mean and median total cost of TB illness to patient were $177.3 (SD = 78.7) and $177.1 (R = 461.8), respectively. The total cost had significant association with patient's household income, residence, need for additional food, and primary income (P <0.05). Direct costs were catastrophic for 63 % of TB patients, regardless of significant difference between gender (P = 0.92) and type of TB cases (P = 0.37). TB patients mean productivity and income reduced by 37 and 10 %, respectively, compared with pre-treatment level, while mean household expenditure increased by 33 % and working hours reduced by 78 % due to TB illness. Income quartile categories were directly correlated with catastrophic costs (η = 0.684). CONCLUSION Despite the availability of free-of-charge anti-TB drugs, TB patients were suffering from out-of-pocket payments with catastrophic consequences, which in turn were hampering the efforts to end TB. TB patients in resource-limited countries deserve integrated patient-centered care with comprehensive health insurance coverage, financial incentives, and nutrition support to reduce catastrophic costs and retain them in care. Such countries should induce home-based directly observed therapy programs to reduce costs due to attending health facilities, intensify home treatment of critically-ill patients with impaired mobility, and reduce the spread of TB due to patients traveling to seek care.
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Affiliation(s)
- Belete Getahun
- Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
| | - Moges Wubie
- Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Getiye Dejenu
- Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
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Tang S, Wang L, Wang H, Chin DP. Access to and affordability of healthcare for TB patients in China: issues and challenges. Infect Dis Poverty 2016; 5:10. [PMID: 26822583 PMCID: PMC4731945 DOI: 10.1186/s40249-016-0096-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/04/2016] [Indexed: 11/10/2022] Open
Abstract
This paper introduces the background, aim and objectives of the project entitled "China-the Gates Foundation Collaboration on TB Control in China" that has been underway for many years. It also summarizes the key findings of the nine papers included in this special issue, which used data from the baseline survey of Phase II of the project. Data were collected from the survey of TB and MDR-TB patients, from designated hospitals, health insurance agencies and the routine health information systems, as well as key informant interviews and focus group discussions with relevant key stakeholders. Key issues discussed in this series of papers include the uses of TB services and anti-TB medicines and their determining factors related to socio-economic and health systems development; expenditures on TB care and the financial burden incurred on TB patients; and the impact of health insurance schemes implemented in China on financial protection.
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Affiliation(s)
- Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, USA. .,Global Health Research Center, Duke Kunshan University, Kunshan, China.
| | - Lixia Wang
- National Center for TB control and prevention, China CDC, No 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China.
| | - Hong Wang
- Bill & Melinda Gates Foundation, Seattle, Washington, USA.
| | - Daniel P Chin
- Bill & Melinda Gates Foundation, Beijing office, Beijing, China.
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