A Care Pathway Analysis of Tuberculosis Patients in Benin: Highlights on Direct Costs and Critical Stages for an Evidence-Based Decision-Making

Abstract

BackgroundFree tuberculosis control fail to protect patients from substantial medical and non-medical expenditure, thus a greater degree of disaggregation of patient cost is needed to fully capture their context and inform policymaking.MethodsA retrospective cross-sectional study was conducted on a convenience sample of six health districts of Southern Benin. From August 2008 to February 2009, we recruited all smear-positive pulmonary tuberculosis patients treated under the national strategy in the selected districts. Direct out-of-pocket costs associated with tuberculosis, time delays, and care-seeking pattern were collected from symptom onset to end of treatment.ResultsPopulation description and outcome data were reported for 245 patients of whom 153 completed their care pathway. For them, the median overall direct cost was USD 183 per patient. Payments to traditional healers, self-medication drugs, travel, and food expenditures contributed largely to this cost burden. Patient, provider, and treatment delays were also reported. Pre-diagnosis and intensive treatment stages were the most critical stages, with median expenditure of USD 43 per patient and accounting for 38% and 29% of the overall direct cost, respectively. However, financial barriers differed depending on whether the patient lived in urban or rural areas.ConclusionsThis study delivers new evidence about bottlenecks encountered during the TB care pathway. Financial barriers to accessing the free-of-charge tuberculosis control strategy in Benin remain substantial for low-income households. Irregular time delays and hidden costs, often generated by multiple visits to various care providers, impair appropriate patient pathways. Particular attention should be paid to pre-diagnosis and intensive treatment. Cost assessment and combined targeted interventions embodied by a patient-centered approach on the specific critical stages would likely deliver better program outcomes.

Multidrug-resistant tuberculosis patients' views of interventions to reduce treatment loss to follow-up

“…Reports in the literature indicate that some TB patients expend their limited resources while pursuing a diagnosis. 13,14 Furthermore, missed doses early in the course of treatment can become self-defeating for the patient 15 and create an unfavorable impression of the patient among care givers. An efficient process is therefore needed to register patients into an assistance program, deliver initial help, and institute safeguards to avoid exploitation of available assistance.…”

Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities

“…(), Figure and built a thirty‐page questionnaire to appraise the multidimensional economic burden of illness in a user's perspective (Laokri et al . ). Data collection focused on socio‐economic status, care‐seeking behaviours, direct, indirect and intangible costs of TB, as well as strategies developed by households to cope with these costs.…”

“…The breakdown analysis of the direct costs in every stage of the TB care‐seeking pathway has been reported in a related paper (Laokri et al . ). The indirect costs were defined by the time lost by the patient, guardian and informal caregiver because of travel to seek care, waiting for consultation, or illness.…”

“…A retrospective cross‐sectional study was conducted using a standardised questionnaire (Laokri et al . ,b, ). Depicting the concept of ‘medical poverty trap’ (Whitehead et al .…”

“…Despite TB care delivered under the free directly observed treatment, short‐course (DOTS) programme, financial barriers to appropriate care‐seeking may remain as well as the risk of illness poverty trap (Laokri et al . , ). The risk of being further impoverished due to TB and the related determinants are now essential to enhance effective care coverage (Ukwaja et al .…”