Catastrophic costs due to tuberculosis in South India: comparison between active and passive case finding

Abstract

Background To measure and compare economic burden at the household level for tuberculosis (TB) patients who were detected through active case finding (ACF) and passive case finding (PCF) in rural areas. Methods This study was conducted in the Thiruvallur district from October 2016 to March 2018. TB patients diagnosed through ACF were included in this study. For the comparison, patients diagnosed through ACF were recruited in the ratio of 1:2 from the same study area during the same period. Costs between the groups were compared and a multiple regression model was used to identify factors associated with catastrophic costs due to TB. Results Of the 336 individuals, 110 were diagnosed through ACF and 226 through PCF. A total of 29% of patients diagnosed through PCF and 9% of patients diagnosed through ACF experienced catastrophic costs due to TB. The multiple logistic model shows that catastrophic costs due to TB had a significant association with higher income status (adjusted odds ratio [aOR] 4.91 [confidence interval {CI} 2.39 to 10.08]; p<0.001), alcohol use (aOR 2.78 [CI 1.33 to 5.81]; p=0.007), private as a first point of care (aOR 3.91 [CI 2.01 to 7.60]; p<0.001) and PCF (aOR 3.68 [CI 1.62 to 8.33]; p=0.002). Conclusions Findings highlight that ACF significantly averted catastrophic costs due to TB among patients. ACF as a strategy could ensure financial protection of TB patients and limit their risk of poverty.

Costs incurred by patients with drug-susceptible pulmonary tuberculosis in semi-urban and rural settings of Western India

“…The median costs reported in the present study were lower than those reported in most other studies from India [9,10,12,13,16,17,22,23]. The discrepancy might be because the current study estimated the costs among drug-susceptible pulmonary TB patients, whereas the published literature is inclusive of cost estimates on drug-resistant and extra-pulmonary TB patients.…”

“…Studies in India reported the percentage of catastrophic costs among drug-susceptible TB patients to be between 7 and 32% [ 9 – 12 ]. The average costs incurred by drug-susceptible TB patients treated in government health facilities are approximately USD 179, [ 9 , 10 ] whereas costs incurred by TB patients accessing care in all types of health facilities range from USD 20 to 224 [ 13 – 17 ]. In response to call for additional socioeconomic support for TB patients, the National TB Program (NTP) in India rolled out a direct benefit transfer (DBT) scheme in April 2018 with a credit of USD 7 (Indian Rupees [INR] 500) every month to support the nutritional requirements of TB patients [ 18 ].…”

Status and challenges for tuberculosis control in India – Stakeholders' perspective

“…It has been shown that Active Case Finding (ACF) as compared to Passive case finding significantly averts catastrophic costs due to TB among patients. ACF as a strategy could ensure financial protection of TB patients and limit their risk of poverty 24 . In addition, TB elimination efforts need to focus on all forms of TB, including Extra Pulmonary TB, leaving no one behind, in order to realise the dream of ending TB 25 .…”

Trade-offs between cost and accuracy in active case finding for tuberculosis: A dynamic modelling analysis

“…Finally, we tracked the costs of treating false-positive TB diagnoses, as driven by the imperfect specificity of the screening and diagnostic tools involved, and the low prevalence of TB (<5% amongst those with symptoms, even in urban slums). Unnecessary TB treatment carries heavy societal costs, including avoidable stigma [13], as well as the monetary costs to patients and households (e.g., travel costs) involved in completing a regimen of TB treatment [18]. Such factors are outside the scope of our current study: Here we focus on unnecessary programmatic spending on the treatment of false-positive TB, recognising (as discussed below) that this approach represents only one narrow part of the overall adverse effects of false-positive treatment [13].…”

“…In the context of routine TB services, the costs of care-seeking and TB treatment can have a substantial impact on productivity and household income, and are an important cause of catastrophic health expenditure [29]. Previous work in India has shown that ACF can bring about substantial reductions in these patient costs [18], essentially by bringing TB services to those in need in a timely way. By neglecting patient costs, our analysis therefore does not capture the societal cost savings that would result from higher-sensitivity testing strategies.…”