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Chatterjee S, Das P, Stallworthy G, Bhambure G, Munje R, Vassall A. Catastrophic costs for tuberculosis patients in India: Impact of methodological choices. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003078. [PMID: 38669225 PMCID: PMC11051603 DOI: 10.1371/journal.pgph.0003078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/16/2024] [Indexed: 04/28/2024]
Abstract
As financial risk protection is one of the goals towards universal health coverage, detailed information on costs, catastrophic costs and other economic consequences related to any disease are required for designing social protection measures. End Tuberculosis (TB) Strategy set a milestone of achieving zero catastrophic cost by 2020. However, a recent literature review noted that 7%-32% TB affected households in India faced catastrophic cost. Studies included in the review were small scale cross-sectional. We followed a cohort of 1482 notified drug-susceptible TB patients from four states in India: Assam, Maharashtra, Tamil Nadu, and West Bengal to provide a comprehensive picture of economic burden associated with TB treatment. Treatment cost was calculated using World Health Organization guidelines on TB patient cost survey and both human capital and output approaches of indirect cost (time, productivity, and income loss related to an episode) calculation were used to provide the range of households currently facing catastrophic cost. Depending on choice of indirect cost calculation method, 30%-61% study participants faced catastrophic cost. For over half of them, costs became catastrophic even before starting TB treatment as there was average 7-9 weeks delay from symptom onset to treatment initiation which was double the generally accepted delay of 4 weeks. During that period, they made average 8-11 visits to different providers and spent money on consultations, drugs, tests, and travel. Following the largest cohort of drug-susceptible TB patients till date, the study concluded that a significant proportion of study participants faced catastrophic cost and the proportion was much higher when income loss was considered as indirect cost calculation method. Therefore, ensuring uninterrupted livelihood during TB treatment is an absolute necessity. Another reason of high cost was the delay in diagnosis and costs incurred during pre-diagnosis period. This delay and consequently, economic burden, can be reduced by both supply side (intense private sector engagement, rapid diagnosis) and demand side (community engagement) initiatives. Reimbursement of expenses incurred before treatment initiation could be used as short-term measure for mitigating financial hardship.
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Affiliation(s)
- Susmita Chatterjee
- Research Department, George Institute for Global Health, New Delhi, India
- Department of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Palash Das
- Research Department, George Institute for Global Health, New Delhi, India
| | - Guy Stallworthy
- Bill & Melinda Gates Foundation, Global Health Division, Seattle, Washington State, United States of America
| | - Gayatri Bhambure
- Research Department, George Institute for Global Health, New Delhi, India
| | - Radha Munje
- Department of Respiratory Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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2
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Yamanaka T, Castro MC, Ferrer JP, Cox SE, Laurence YV, Vassall A. Comparing disease specific catastrophic cost estimates using longitudinal and cross-sectional designs: The example of tuberculosis. Soc Sci Med 2024; 344:116631. [PMID: 38308959 DOI: 10.1016/j.socscimed.2024.116631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND There has been an increasing interest in assessing disease-specific catastrophic costs incurred by affected households as part of economic evaluations and to inform joint social/health policies for vulnerable groups. Although the longitudinal study design is the gold standard for estimating disease-specific household costs, many assessments are implemented with a cross-sectional design for pragmatic reasons. We aimed at identifying the potential biases of a cross-sectional design for estimating household cost, using the example of tuberculosis (TB), and exploring optimal approaches for sampling and interpolating cross-sectional cost data to estimate household costs. METHODS Data on patient incurred costs, household income and coping strategies were collected from TB patients in Negros Occidental and Cebu in the Philippines between November 2018 and October 2020. The data collection tools were developed by adapting WHO Tuberculosis Patient Cost Surveys: A Handbook into a longitudinal study design. TB-specific catastrophic cost estimates were compared between longitudinal and simulated cross-sectional designs using different random samples from different times points in treatment (intensive and continuation phases). RESULTS A total of 530 adult TB patients were enrolled upon TB diagnosis in this study. Using the longitudinal design, the catastrophic cost estimate for TB-affected households was 69 % using the output approach. The catastrophic cost estimates with the simulated cross-sectional design were affected by the reduction and recovery in household income during the episode of TB care and ranged from 40 to 55 %. CONCLUSION Using longitudinally collected costs incurred by TB-affected households, we illustrated the potential limitations and implications of estimating household costs using a cross-sectional design. Not capturing changes in household income at multiple time points during the episode of the disease and estimating from inappropriate samples may result in biases that underestimates catastrophic cost.
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Affiliation(s)
- Takuya Yamanaka
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
| | | | | | - Sharon E Cox
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Institute of Tropical Medicine, Nagasaki University (NEKKEN), Nagasaki, Japan; UK Health Security Agency, London, UK
| | - Yoko V Laurence
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK; Health Economics for Life Sciences and Medicine, Department of Population Health Sciences, King's College London, London, UK
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Nhassengo P, Yoshino C, Zandamela A, De Carmo V, Burström B, Lönnroth K, Wingfield T, Khosa C, Atkins S. 'They didn't look at me with good eyes' - experiences of the socioeconomic impact of tuberculosis and support needs among adults in a semi-rural area in Mozambique: A Qualitative Study. Glob Public Health 2024; 19:2311682. [PMID: 38325424 DOI: 10.1080/17441692.2024.2311682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
Tuberculosis is recognised as a disease of the economically disadvantaged people due to its association with financial vulnerability. Mozambique still faces the challenge of the high burden of TB and associated costs. We aimed to understand the social and economic impacts of TB and the need for social support among people with TB in Mozambique. We conducted a qualitative study using a phenomenological approach focusing on the lived experiences and perceptions of people with TB. A total of 52 semi-structured one-to-one in-depth interviews were conducted and data were analysed using a reflexive thematic analysis. Three themes were drawn from the analysis: (i) TB has a social and economic impact that requires adaptation and resourcefulness amongst those affected; (ii) People with TB have different preferences and needs for social support, and (iii) People with TB have different knowledge of, and experiences with, formal social support. TB affects family and community relationships mainly due to impacts on the household's finances. People with TB in Mozambique are not entitled to any form of social support, and they need to rely on help from family and the community which is often insufficient. Further investigation is needed on how social support schemes can be developed in Mozambique.
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Affiliation(s)
- Pedroso Nhassengo
- WHO Collaborating Centre in Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Instituto Nacional de Saúde, Marracuene, Mozambique
- Health and Social Protection Action Research and Knowledge Sharing Network (www.sparksnetwork.ki.se), Stockholm, Sweden
| | - Clara Yoshino
- WHO Collaborating Centre in Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Health and Social Protection Action Research and Knowledge Sharing Network (www.sparksnetwork.ki.se), Stockholm, Sweden
| | | | | | - Bo Burström
- WHO Collaborating Centre in Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Health and Social Protection Action Research and Knowledge Sharing Network (www.sparksnetwork.ki.se), Stockholm, Sweden
| | - Knut Lönnroth
- WHO Collaborating Centre in Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Health and Social Protection Action Research and Knowledge Sharing Network (www.sparksnetwork.ki.se), Stockholm, Sweden
| | - Tom Wingfield
- WHO Collaborating Centre in Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Health and Social Protection Action Research and Knowledge Sharing Network (www.sparksnetwork.ki.se), Stockholm, Sweden
- Departments of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Diseases Unit, Liverpool University Hospital NHS, Foundation Trust, Liverpool, UK
| | - Celso Khosa
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Salla Atkins
- WHO Collaborating Centre in Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Health and Social Protection Action Research and Knowledge Sharing Network (www.sparksnetwork.ki.se), Stockholm, Sweden
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- WHO Collaborating Centre on Health in All Policies and Social Determinants of Health, Tampere University, Tampere, Finland
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Noia Maciel EL, Negri LDSA, Guidoni LM, Fregona GC, Johansen FDC, Sanchez MN, Moreira ADSR, Diaz-Quijano FA, Tonini M, Zandonade E, Ershova J, Nguhiu P, Baena IG. The economic burden of households affected by tuberculosis in Brazil: First national survey results, 2019-2021. PLoS One 2023; 18:e0287961. [PMID: 38091306 PMCID: PMC10718450 DOI: 10.1371/journal.pone.0287961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 06/19/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a baseline, the magnitude and main drivers of the costs associated with TB disease for patients and their households and to monitor the proportion of households experiencing catastrophic costs in Brazil. METHODS A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors (<18 years old) were interviewed once about costs, time loss, coping measures, income, household expenses, and asset ownership. Total costs, including indirect costs measured as reported household income change, were expressed as a percentage of annual household income. We used descriptive statistics to analyze the cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs. RESULTS We interviewed 603 patients, including 538 (89%) with drug-sensitive (DS) and 65 (11%) with drug-resistant (DR) TB. Of 603 affected households, 48.1% (95%CI: 43-53.2) experienced costs above 20% of their annual household income during their TB episode. The proportion was 44.4% and 78.5% among patients with DS- and DR-TB, respectively. On average, patients incurred costs of US$1573 (95%CI: 1361.8-1785.0) per TB episode, including pre-diagnosis and post-diagnosis expenses. Key cost drivers were post-diagnosis nutritional supplements (US$317.6, 95%CI: 232.7-402.6) followed by medical costs (US$85.5, 95%CI: 54.3-116.5) and costs of travel for clinic visits during treatment (US$79.2, 95%CI: 61.9-96.5). In multivariate analysis, predictors of catastrophic costs included positive HIV status (aOR = 3.0, 95%CI:1.1-8.6) and self-employment (aOR = 2.7, 95%CI:1.1-6.5); high education was a protective factor (aOR = 0.1, 95%CI:0.0-0.9). CONCLUSIONS Although the services offered to patients with TB are free of charge in the Brazilian public health sector, the availability of free diagnosis and treatment services does not alleviate patients' financial burden related to accessing TB care. The study allowed us to identify the costs incurred by patients and suggest actions to mitigate their suffering. In addition, this study established a baseline for monitoring catastrophic costs and fostering a national policy to reduce the costs to patients for TB care in Brazil.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Maiko Tonini
- University of Brasília, UNB, Brasília, DF, Brazil
| | | | - Julia Ershova
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Peter Nguhiu
- KEMRI- Wellcome Trust Research Program, Health Economics Research Unit, Nairobi, Kenya
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Bhatia V, Rijal S, Sharma M, Islam A, Vassall A, Bhargava A, Thida A, Basri C, Onozaki I, Pai M, Rezwan MK, Arinaminpathy N, Chandrashekhar P, Sarin R, Mandal S, Raviglione M. Ending TB in South-East Asia: flagship priority and response transformation. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 18:100301. [PMID: 38028166 PMCID: PMC10667305 DOI: 10.1016/j.lansea.2023.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023]
Abstract
Over the decades, the global tuberculosis (TB) response has evolved from sanatoria-based treatment to DOTS (Directly Observed Therapy Shortcourse) strategy and the more recent End TB Strategy. The WHO South-East Asia Region, which accounted for 45% of new TB patients and 50% of deaths globally in 2021, is pivotal to the global fight against TB. "Accelerate Efforts to End TB" by 2030 was adopted as a South-East Asia Regional Flagship Priority (RFP) in 2017. This article illustrates intensified and transformed approaches to address the disease burden following the adoption of RFP and new challenges that emerged during the COVID-19 pandemic. TB case notifications improved by 25% and treatment success rates improved by 6% between 2016 and 2019 due to interventions ranging from galvanising political commitments to empowering and engaging communities. Cumulative TB programme budget allocations in 2022 reached US$ 1.4 billion, about two and a half times the budget in 2016. An ambitious Regional Strategic Plan towards ending TB, 2021-2025, identifies priority interventions that will need investments of up to US$ 3 billion a year to fully implement them. Moving forward, countries in the Region need to leverage RFP and take up intensified, people-centred, holistic interventions for prevention, diagnosis, treatment and care of TB with commensurate investments and cross-ministerial and multi-sectoral coordination.
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Affiliation(s)
- Vineet Bhatia
- Department of Communicable Diseases, WHO South-East Asia Regional Office, India
| | - Suman Rijal
- Department of Communicable Diseases, WHO South-East Asia Regional Office, India
| | - Mukta Sharma
- Department of Communicable Diseases, WHO Country Office, Indonesia
| | | | | | | | - Aye Thida
- Department of Communicable Diseases, WHO South-East Asia Regional Office, India
| | | | | | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Md Kamar Rezwan
- Department of Communicable Diseases, WHO South-East Asia Regional Office, India
| | | | | | - Rohit Sarin
- Independent Consultant for Tuberculosis, India
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6
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Singh PK. Strengthening social protection for TB patients: Lessons from COVID-19. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000950. [PMID: 36962874 PMCID: PMC10021847 DOI: 10.1371/journal.pgph.0000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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7
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du Preez K, Gabardo BMA, Kabra SK, Triasih R, Lestari T, Kal M, Tsogt B, Dorj G, Purev E, Nguyen TA, Naidoo L, Mvusi L, Schaaf HS, Hesseling AC, de Oliveira Rossoni AM, Carvalho ACC, Cardoso CAA, Sant’Anna CC, Orti DGD, Costa FD, Vega LR, Sant’Anna MDFP, Hoa NB, Phuc PH, Fiogbe AA, Affolabi D, Badoum G, Ouédraogo AR, Saouadogo T, Combary A, Kuate Kuate A, Prudence BNA, Magassouba AS, Bangoura AM, Soumana A, Hermana G, Gando H, Fall N, Gning B, Dogo MF, Mbitikon O, Deffense M, Zimba K, Chabala C, Sekadde MP, Luzze H, Turyahabwe S, Dongo JP, Lopes C, dos Santos M, Francis JR, Arango-Loboguerrero M, Perez-Velez CM, Koura KG, Graham SM. Priority Activities in Child and Adolescent Tuberculosis to Close the Policy-Practice Gap in Low- and Middle-Income Countries. Pathogens 2022; 11:196. [PMID: 35215139 PMCID: PMC8878304 DOI: 10.3390/pathogens11020196] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 01/25/2023] Open
Abstract
Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause of child and adolescent morbidity and mortality-over one and a half million children and adolescents develop TB each year. A history of the global public health perspective on child and adolescent TB is followed by 12 narratives detailing challenges and progress in 19 TB endemic low and middle-income countries. Overarching challenges include: under-detection and under-reporting of child and adolescent TB; poor implementation and reporting of contact investigation and TB preventive treatment services; the need for health systems strengthening to deliver effective, decentralized services; and lack of integration between TB programs and child health services. The COVID-19 pandemic has had a significant negative impact on case detection and treatment outcomes. Child and adolescent TB working groups can address country-specific challenges to close the policy-practice gaps by developing and supporting decentral ized models of care, strengthening clinical and laboratory diagnosis, including of multidrug-resistant TB, providing recommended options for treatment of disease and infection, and forging strong collaborations across relevant health sectors.
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Affiliation(s)
- Karen du Preez
- Desmond Tutu Tuberculosis Center, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (H.S.S.); (A.C.H.)
| | - Betina Mendez Alcântara Gabardo
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Sushil K. Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India;
| | - Rina Triasih
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (R.T.); (T.L.)
| | - Trisasi Lestari
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (R.T.); (T.L.)
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia;
| | - Margaret Kal
- National Department of Health, Port Moresby 131, Papua New Guinea;
| | | | - Gantsetseg Dorj
- Tuberculosis Surveillance and Research Department, National Center for Communicable Diseases, Ulaanbaatar 210648, Mongolia;
| | - Enkhtsetseg Purev
- Tuberculosis Clinic, National Center for Communicable Diseases, Ulaanbaatar 210648, Mongolia;
| | - Thu Anh Nguyen
- Woolcock Institute of Medical Research, Ha Noi 100000, Vietnam;
| | - Lenny Naidoo
- Health Department, Cape Town 8000, South Africa;
| | - Lindiwe Mvusi
- National TB Control & Management Cluster, National Department of Health, Pretoria 0187, South Africa;
| | - Hendrik Simon Schaaf
- Desmond Tutu Tuberculosis Center, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (H.S.S.); (A.C.H.)
| | - Anneke C. Hesseling
- Desmond Tutu Tuberculosis Center, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (H.S.S.); (A.C.H.)
| | - Andrea Maciel de Oliveira Rossoni
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Anna Cristina Calçada Carvalho
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21045-900, Brazil
| | - Claudete Aparecida Araújo Cardoso
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Clemax Couto Sant’Anna
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Danielle Gomes Dell’ Orti
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
| | - Fernanda Dockhorn Costa
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
| | - Liliana Romero Vega
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
| | - Maria de Fátima Pombo Sant’Anna
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | | | - Phan Huu Phuc
- National Pediatric Hospital, Ha Noi 100000, Vietnam;
| | - Attannon Arnauld Fiogbe
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Cotonou 03 BP 2819, Benin;
| | - Dissou Affolabi
- National Tuberculosis Program, Cotonou 03 BP 2819, Benin;
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou 03 BP 2819, Benin
| | - Gisèle Badoum
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- Health Sciences Unit, University Joseph Ki-Zerbo, Ouagadougou 03 BP 7047, Burkina Faso
- Ministry of Health National Tuberculosis Program, Ouagadougou 03 BP 7047, Burkina Faso;
| | - Abdoul Risgou Ouédraogo
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- Health Sciences Unit, University Joseph Ki-Zerbo, Ouagadougou 03 BP 7047, Burkina Faso
- Ministry of Health National Tuberculosis Program, Ouagadougou 03 BP 7047, Burkina Faso;
| | - Tandaogo Saouadogo
- Ministry of Health National Tuberculosis Program, Ouagadougou 03 BP 7047, Burkina Faso;
| | - Adjima Combary
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Yaoundé BP 6000, Cameroon;
| | - Albert Kuate Kuate
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Yaoundé BP 6000, Cameroon;
| | | | - Aboubakar Sidiki Magassouba
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Conakry 63570, Guinea;
| | | | - Alphazazi Soumana
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Niamey 22 646, Niger
| | - Georges Hermana
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Bangui BP 729, Central African Republic;
| | - Hervé Gando
- National Tuberculosis Program, Bangui BP 729, Central African Republic;
| | - Nafissatou Fall
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Dakar 12000, Senegal;
| | - Barnabé Gning
- National Tuberculosis Program, Dakar 12000, Senegal;
| | - Mohammed Fall Dogo
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Lomé BP 526, Togo
| | - Olivia Mbitikon
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Bangui BP 729, Central African Republic;
| | - Manon Deffense
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
| | - Kevin Zimba
- Lusaka Provincial Health Office, Ministry of Health, Lusaka 10101, Zambia;
| | - Chishala Chabala
- Department of Pediatrics and Child Health, School of Medicine, University of Zambia, Lusaka 10101, Zambia;
- Children’s Hospital, University Teaching Hospitals, Lusaka 10101, Zambia
| | | | - Henry Luzze
- National Tuberculosis and Leprosy Program, Kampala 7025, Uganda; (M.P.S.); (H.L.); (S.T.)
| | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Program, Kampala 7025, Uganda; (M.P.S.); (H.L.); (S.T.)
| | | | - Constantino Lopes
- National Tuberculosis Program, Ministerio da Saude, Dili NM 87109, Timor-Leste;
| | - Milena dos Santos
- Hospital Nacional Guido Valadares, Ministerio da Saude, Dili NM 87109, Timor-Leste;
| | | | | | - Carlos M. Perez-Velez
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, AZ 85721, USA;
| | - Kobto Ghislain Koura
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- COMUE Sorbonne Paris Cité, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, 75006 Paris, France
- École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Epidémiologique, Université de Parakou, Parakou 03 BP 351, Benin
| | - Stephen M. Graham
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- Department of Pediatrics, Murdoch Childrens Research Institute, University of Melbourne Royal Children’s Hospital, Melbourne, VIC 3052, Australia
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8
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Ghazy RM, El Saeh HM, Abdulaziz S, Hammouda EA, Elzorkany AM, Khidr H, Zarif N, Elrewany E, Abd ElHafeez S. A systematic review and meta-analysis of the catastrophic costs incurred by tuberculosis patients. Sci Rep 2022; 12:558. [PMID: 35017604 PMCID: PMC8752613 DOI: 10.1038/s41598-021-04345-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 12/13/2021] [Indexed: 12/20/2022] Open
Abstract
One of the strategies of the World Health Organization End Tuberculosis (TB) was to reduce the catastrophic costs incurred by TB-affected families to 0% by 2020.Catastrophic cost is defined by the total cost related to TB management exceeding 20% of the annual pre-TB household income. This study aimed to estimate the pooled proportion of TB affected households who incurred catastrophic costs. We searched PubMed, SciELO, Scopus, Embase, Google Scholar, ProQuest, SAGE, and Web of Science databases according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines till November 20, 2020. Eligible studies were identified and data on catastrophic costs due to TB were extracted. We performed a meta-analysis to generate the pooled proportion of patients with TB facing catastrophic costs. From 5114 studies identified, 29 articles were included in the final analysis. The pooled proportion of patients faced catastrophic costs was (43%, 95% CI [34-51]). Meta-regression revealed that country, drug sensitivity, and Human immune-deficiency Virus (HIV) co-infection were the main predictors of such costs. Catastrophic costs incurred by drug sensitive, drug resistant, and HIV co-infection were 32%, 81%, and 81%, respectively. The catastrophic costs incurred were lower among active than passive case findings (12% vs. 30%). Half (50%) of TB-affected households faced catastrophic health expenditure at 10% cut-off point. The financial burden of patients seeking TB diagnosis and treatment continues to be a worldwide impediment. Therefore, the End TB approach should rely on socioeconomic support and cost-cutting initiatives.PROSPERO registration: CRD42020221283.
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Affiliation(s)
- Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Haider M El Saeh
- Community Medicine Department, Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | | | - Heba Khidr
- Ministry of Health and Population, Alexandria, Egypt
| | - Nardine Zarif
- Ministry of Health and Population, Alexandria, Egypt
| | - Ehab Elrewany
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Samar Abd ElHafeez
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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9
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Viney K, Itogo N, Yamanaka T, Jebeniani R, Hazarika A, Morishita F, Nishikiori N, Nery SV. Economic evaluation of patient costs associated with tuberculosis diagnosis and care in Solomon Islands. BMC Public Health 2021; 21:1928. [PMID: 34688266 PMCID: PMC8542301 DOI: 10.1186/s12889-021-11938-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) care can be costly for patients and their families. The End TB Strategy includes a target that zero TB affected households should experience catastrophic costs associated with TB care. Costs are catastrophic when a patient spends 20% or more of their annual household income on their TB diagnosis and care. In Solomon Islands the costs of TB care are unknown. The aim of this study was to determine the costs of TB diagnosis and care, the types of costs and the proportion of patients with catastrophic costs. METHODS This was a nationally representative cross-sectional survey of TB patients carried out between 2017 and 2019. Patients were recruited from health care facilities, from all ten provinces in Solomon Islands. During an interview they were asked about the costs of TB diagnosis and care. These data were analysed using descriptive statistics to describe the costs overall and the proportions of different types of costs. The proportion of patients with catastrophic costs was calculated and a multivariate logistic regression was undertaken to determine factors associated with catastrophic costs. RESULTS One hundred and eighty-three TB patients participated in the survey. They spent a mean of 716 USD (inter quartile range: 348-1217 USD) on their TB diagnosis and care. Overall, 62.1% of costs were attributable to non-medical costs, while income loss and medical costs comprised 28.5 and 9.4%, respectively. Overall, 19.7% (n = 36) of patients used savings, borrowed money, or sold assets as a financial coping mechanism. Three patients (1.6%) had health insurance. A total of 92.3% (95% CI: 88.5-96.2) experienced catastrophic costs, using the output approach. Being in the first, second or third poorest wealth quintile was significantly associated with catastrophic costs (adjusted odds ratio: 67.3, 95% CI: 15.86-489.74%, p < 0.001). CONCLUSION The costs of TB care are catastrophic for almost all patients in Solomon Islands. The provision of TB specific social and financial protection measures from the National TB and Leprosy Programme may be needed in the short term to ameliorate these costs. In the longer term, advancement of universal health coverage and other social and financial protection measures should be pursued.
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Affiliation(s)
- Kerri Viney
- Research School of Population Health, Australian National University, Canberra, Australia.
- Global TB Programme, World Health Organization Headquarters, Geneva, Switzerland.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Noel Itogo
- National TB Programme, Ministry of Health and Medical Services, Honiara, Solomon Islands
- World Health Organization Country Office, Honiara, Solomon Islands
| | - Takuya Yamanaka
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Anupama Hazarika
- World Health Organization Country Office, Honiara, Solomon Islands
| | - Fukushi Morishita
- End TB and Leprosy Unit, World Health Organization Regional Office of the Western Pacific, Manila, Philippines
| | - Nobuyuki Nishikiori
- Global TB Programme, World Health Organization Headquarters, Geneva, Switzerland
| | - Susana Vaz Nery
- Research School of Population Health, Australian National University, Canberra, Australia
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia
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10
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Ghazy RM, Saeh HME, Abdulaziz S, Hammouda EA, Elzorkany A, Kheder H, Zarif N, Elrewany E, Elhafeez SA. A Systematic Review and Meta-Analysis on Catastrophic Cost incurred by Tuberculosis Patients and their Households.. [DOI: 10.1101/2021.02.27.21252453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
AbstractBackgroundAs one of the World Health Organization (WHO) End Tuberculosis (TB) Strategy is to reduce the proportion of TB affected families that face catastrophic costs to 0% by 2020. This systematic review and meta-analysis aimed to estimate the pooled proportion of TB affected households who face catastrophic cost.MethodA search of the online database through September 2020 was performed. A total of 5114 articles were found, of which 29 articles got included in quantitative synthesis. Catastrophic cost is defined if total cost related to TB exceeded 20% of annual pre-TB household income. R software was used to estimate the pooled proportion at 95% confidence intervals (CIs) using the fixed/random-effect models.ResultThe proportion of patients faced catastrophic cost was 43% (95% CI 34-52, I2= 99%); 32% (95% CI 29 – 35, I2= 70%) among drug sensitive, and 80% (95% CI 74-85, I2= 54%) among drug resistant, and 81% (95%CI 78-84%, I2= 0%) among HIV patients. Regarding active versus passive case finding the pooled proportion of catastrophic cost was 12% (95% CI 9-16, I2= 95%) versus 42% (95% CI 35-50, I2= 94%). The pooled proportion of direct cost to the total cost was 45% (95% CI 39-51, I2= 91%). The pooled proportion of patients facing catastrophic health expenditure (CHE) at cut of point of 10% of their yearly income was 45% (95% CI 35-56, I2= 93%) while at 40% of their capacity to pay was 63% (95% CI 40-80, I2= 96%).ConclusionDespite the ongoing efforts, there is a significant proportion of patients facing catastrophic cost, which represent a main obstacle against TB control.PROSPERO registrationCRD42020221283
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11
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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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12
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Chittamany P, Yamanaka T, Suthepmany S, Sorsavanh T, Siphanthong P, Sebert J, Viney K, Vixaysouk T, Nagai M, Seevisay V, Izumi K, Morishita F, Nishikiori N. First national tuberculosis patient cost survey in Lao People's Democratic Republic: Assessment of the financial burden faced by TB-affected households and the comparisons by drug-resistance and HIV status. PLoS One 2020; 15:e0241862. [PMID: 33180777 PMCID: PMC7660466 DOI: 10.1371/journal.pone.0241862] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/22/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) patients incur large costs for care seeking, diagnosis, and treatment. To understand the magnitude of this financial burden and its main cost drivers, the Lao People's Democratic Republic (PDR) National TB Programme carried out the first national TB patient cost survey in 2018-2019. METHOD A facility-based cross-sectional survey was conducted based on a nationally representative sample of TB patients from public health facilities across 12 provinces. A total of 848 TB patients including 30 drug resistant (DR)-TB and 123 TB-HIV coinfected patients were interviewed using a standardised questionnaire developed by the World Health Organization. Information on direct medical, direct non-medical and indirect costs, as well as coping mechanisms was collected. We estimated the percentage of TB-affected households facing catastrophic costs, which was defined as total TB-related costs accounting for more than 20% of annual household income. RESULT The median total cost of TB care was US$ 755 (Interquartile range 351-1,454). The costs were driven by direct non-medical costs (46.6%) and income loss (37.6%). Nutritional supplements accounted for 74.7% of direct non-medical costs. Half of the patients used savings, borrowed money or sold household assets to cope with TB. The proportion of unemployment more than doubled from 16.8% to 35.4% during the TB episode, especially among those working in the informal sector. Of all participants, 62.6% of TB-affected households faced catastrophic costs. This proportion was higher among households with DR-TB (86.7%) and TB-HIV coinfected patients (81.1%). CONCLUSION In Lao PDR, TB patients and their households faced a substantial financial burden due to TB, despite the availability of free TB services in public health facilities. As direct non-medical and indirect costs were major cost drivers, providing free TB services is not enough to ease this financial burden. Expansion of existing social protection schemes to accommodate the needs of TB patients is necessary.
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Affiliation(s)
| | - Takuya Yamanaka
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | | | | | - Jacques Sebert
- National TB Programme, Ministry of Health, Vientiane, Lao PDR
| | - Kerri Viney
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
- Research School of Population Health, Australian National University, Canberra, Australia
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Moeko Nagai
- World Health Organization, Country Office, Vientiane, Lao PDR
| | - Vilath Seevisay
- World Health Organization, Country Office, Vientiane, Lao PDR
| | - Kiyohiko Izumi
- World Health Organization, Country Office, Vientiane, Lao PDR
| | - Fukushi Morishita
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Nobuyuki Nishikiori
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
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