Catastrophic costs potentially averted by tuberculosis control in India and South Africa: a modelling study

Abstract

SummaryBackgroundThe economic burden on households affected by tuberculosis through costs to patients can be catastrophic. WHO's End TB Strategy recognises and aims to eliminate these potentially devastating economic effects. We assessed whether aggressive expansion of tuberculosis services might reduce catastrophic costs.MethodsWe estimated the reduction in tuberculosis-related catastrophic costs with an aggressive expansion of tuberculosis services in India and South Africa from 2016 to 2035, in line with the End TB Strategy. Using modelled incidence and mortality for tuberculosis and patient-incurred cost estimates, we investigated three intervention scenarios: improved treatment of drug-sensitive tuberculosis; improved treatment of multidrug-resistant tuberculosis; and expansion of access to tuberculosis care through intensified case finding (South Africa only). We defined tuberculosis-related catastrophic costs as the sum of direct medical, direct non-medical, and indirect costs to patients exceeding 20% of total annual household income. Intervention effects were quantified as changes in the number of households incurring catastrophic costs and were assessed by quintiles of household income.FindingsIn India and South Africa, improvements in treatment for drug-sensitive and multidrug-resistant tuberculosis could reduce the number of households incurring tuberculosis-related catastrophic costs by 6–19%. The benefits would be greatest for the poorest households. In South Africa, expanded access to care could decrease household tuberculosis-related catastrophic costs by 5–20%, but gains would be seen largely after 5–10 years.InterpretationAggressive expansion of tuberculosis services in India and South Africa could lessen, although not eliminate, the catastrophic financial burden on affected households.FundingBill & Melinda Gates Foundation.

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

“…Globally, it is estimated that even with aggressive expansion of TB services (includes multi-drug resistant TB services and ACF), catastrophic costs would decrease only by 5–20% by 2035 (base year: 2015) [39]. Hence, countries need to move towards universal health coverage and social protection.…”

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

“…Our estimate of direct cost is closer to the pooled estimate of US$61 considered as the direct cost of base care for drug-sensitive TB Care by Verguet et al . [14]. Another study from Chennai, India reported a mean total cost of US$48 [9].…”

“…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]. They reported that only this threshold was most strongly associated with adverse TB outcome as against 10% or 15%.…”

“…Unnecessary hospitalizations, not an uncommon practice in the private sector, should not be ignored. Interventions to addressing varying qualities of care at multiple care providers towards access to high-quality care could reduce a good portion of catastrophic cost [14]. …”

“…We have excluded MDR TB patients from our study due to small numbers who were enrolled during the study period. The magnitude and pattern of costs for MDR TB patients may not be comparable with drug-sensitive TB patients and thus may skew the estimates [14]. …”