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

Laokri, Samia; Dramaix-Wilmet, Michèle; Kassa, Ferdinand; Anagonou, S.; Dujardin, Bruno

doi:10.1111/tmi.12365

Cited by 53 publications

(75 citation statements)

References 26 publications

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“…Similarly, we identified many studies in the recent period that determined catastrophic costs due to TB care (diagnosis and treatment), but did not provide data specifically for diagnosis [11,33–36]. A systematic review from Africa (studies from 1990 to 2010) revealed that the pre-diagnostic costs for TB varied between 10.4 and 35% of pre-TB AHI [12].…”

Section: Discussionmentioning

confidence: 99%

Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Shewade

Gupta

Satyanarayana

et al. 2018

Global Health Action

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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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Section: Discussionmentioning

confidence: 99%

Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Shewade

Gupta

Satyanarayana

et al. 2018

Global Health Action

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“…Both these studies estimated direct costs only without accounting for the indirect costs. Using a 10% of annual household income cutoff as threshold, 71.8% of the patients in Benin, West Africa experienced the catastrophic impact of TB [22]. With total costs ≥20% of household annual income, 39% Peruvian households incurred catastrophic costs [14].…”

Section: Discussionmentioning

confidence: 99%

Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India

Prasanna

Jeyashree

Chinnakali

et al. 2018

Global Health Action

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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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“…In specific settings, certain dissaving variables may be more relevant to, and correspond more closely with, the likelihood of incurring catastrophic costs. For example, in rural sub-Saharan Africa where formal loans or payments may be less frequent, other dissaving variables such as selling livestock may be more important contributors to dissaving [2]. In addition, while there is scope for measuring dissaving elements longitudinally as a binary variable at different time points throughout TB treatment ( e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, catastrophic costs were defined financially as TB-related out-of-pocket expenses that led to worsening impoverishment of TB-affected households [2–4]. In recent research, we defined a clinically relevant catastrophic costs threshold, demonstrating that TB patients from households that incurred total TB-related household costs of ≥20% of their household annual income were more likely to die, or not complete, or not be cured by, TB treatment [5].…”

Section: Introductionmentioning

confidence: 99%

The economic effects of supporting tuberculosis-affected households in Peru

et al. 2016

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The End TB Strategy mandates that no tuberculosis (TB)-affected households face catastrophic costs due to TB. However, evidence is limited to evaluate socioeconomic support to achieve this change in policy and practice. The objective of the present study was to investigate the economic effects of a TB-specific socioeconomic intervention.The setting was 32 shantytown communities in Peru. The participants were from households of consecutive TB patients throughout TB treatment administered by the national TB programme. The intervention consisted of social support through household visits and community meetings, and economic support through cash transfers conditional upon TB screening in household contacts, adhering to TB treatment/chemoprophylaxis and engaging with social support. Data were collected to assess TB-affected household costs. Patient interviews were conducted at treatment initiation and then monthly for 6 months.From February 2014 to June 2015, 312 households were recruited, of which 135 were randomised to receive the intervention. Cash transfer total value averaged US$173 (3.5% of TB-affected households' average annual income) and mitigated 20% of households' TB-related costs. Households randomised to receive the intervention were less likely to incur catastrophic costs (30% (95% CI 22–38%) versus 42% (95% CI 34–51%)). The mitigation impact was higher among poorer households.The TB-specific socioeconomic intervention reduced catastrophic costs and was accessible to poorer households. Socioeconomic support and mitigating catastrophic costs are integral to the End TB strategy, and our findings inform implementation of these new policies.

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

Abstract: Abstractobjectives To inform policy-making, we measured the risk, causes and consequences of catastrophic expenditures for tuberculosis and investigated potential inequities.

Cited by 53 publications

References 26 publications

Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India

The economic effects of supporting tuberculosis-affected households in Peru

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