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

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.

Cash transfer scheme for people with tuberculosis treated by the National TB Programme in Western India: a mixed methods study

“…It is widely known that households with TB in India experience a high catastrophic cost of TB care during treatment 1 21. Non-medical expenses such as those due to additional food and transport expenses were twice as much as the medical costs12 and mostly occur in the intensive phase of TB treatment 12.…”

‘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

“…This is witnessed by the low TB burden in countries with high social protection and vice-versa [3]. Evidence from several countries including India shows that TB causes catastrophic economic effects on the patients and their households [4][5][6][7][8][9][10]. Ensuring that no TBaffected families face catastrophic expenditure by 2020 is one of the goals of the END TB strategy of the World Health Organization (WHO) [11].…”

Preparedness of outpatient health facilities for ambulatory treatment with all-oral short DR-TB treatment regimens in Zhytomyr, Ukraine: a cross-sectional study

“…Access to facilities was mostly possible by public transport but most facilities were not open after regular office hours. DR-TB treatment is known to lead to catastrophic costs for patients and their households, including travel-costs and due to time spent at the facility for DOT [ 23 , 24 ]. Instead of enforcing DOT, patients-specific approaches on where, when and how to access treatment should be sought [ 25 ].…”