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

Abstract

Background India reports the highest number of tuberculosis (TB) cases worldwide. Poverty has a dual impact as it increases the risk of TB and exposes the poor to economic hardship when they develop TB. Our objective was to estimate the costs incurred by patients with drug-susceptible TB in Bhavnagar (western India) using an adapted World Health Organization costing tool. Methods We conducted a descriptive cross-sectional study of adults, notified in the public sector and being treated for drug-susceptible pulmonary TB during January–June 2019, in six urban and three rural blocks of Bhavnagar region, Gujarat state, India. The direct and indirect TB-related costs, as well as patients’ coping strategies, were assessed for the overall care of TB till treatment completion. Catastrophic costs were defined as total costs > 20% of annual household income (excluding any amount received from cash transfer programs or borrowed). Median and interquartile range (IQR) was used to summarize patient costs. The median costs between any two groups were compared using the median test. The association between any two categorical variables was tested by the Pearson chi-squared test. All costs were described in US dollars (USD). During the study period, on average, one USD equalled 70 Indian Rupees. Results Of 458 patients included, 70% were male, 62% had no formal education, 71% lived in urban areas, and 96% completed TB treatment. The median (IQR) total costs were USD 8 (5–28), direct medical costs were USD 0 (0–0), direct non-medical costs were USD 3 (2–4) and indirect costs were USD 6 (3–13). Among direct non-medical costs, travel cost (median = USD 3, IQR: 2–4) to attend health facilities were the most prominent, whereas the indirect costs were mainly contributed by the patient’s loss of wages (median = USD 3, IQR: 0–6). Four percent of patients faced catastrophic costs, 11% borrowed money to cover costs and 7% lost their employment; the median working days lost to TB was 30 (IQR: 15–45). A majority (88%) of patients received a median USD 43 (IQR: 41–43) as part of a cash transfer program for TB patients. Conclusions Treatment completion was high and the costs incurred by TB patients were low in this setting. However, negative financial consequences occur even in low-cost settings. The role of universal cash transfer programs in such settings requires further study.

Predictors Of Catastrophic Costs Of Tuberculosis (TB) Among Patients Co-Affected With TB-HIV And TB-Diabetes In Bhavnagar Region, Western India

“…Standard of Living (SLI) index: SLI index was categorized into low vs. middle/ high SLI using a summary score calculated based on the possession of assets like the type of house, number of rooms, agricultural land, and others. 6 Data collection, variables, and analysis: We used a validated WHO questionnaire for calculating the catastrophic costs. 4 Data on socio-demographic and other clinical variables were added to the questionnaire.…”

“…4 TB is a diverse disease and so is the prevalence of catastrophic costs incurred due to it in India. 5,6 Globally, the prevalence of catastrophic costs among TB patients is 43% (95% CI 34%-51%), due to drug-sensitive, drug-resistant, and HIV co-infection is 32%, 81%, and 81% respectively. 7 Globally, various studies have documented the predictors of catastrophic costs incurred due to TB.…”

“…7 Globally, various studies have documented the predictors of catastrophic costs incurred due to TB. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Among some recent studies, some of the predictors reported were private provider consultation for the initial visit 6 , hospitalization 16,20 , loss of job 17 , human immunodeficiency virus (HIV) co-infection 7 , lower wealth quintiles 18,20,23 , and drug-resistance. 7,16,18,23 Evidence on predictors of catastrophic costs of TB among patients with TB-HIV co-infection or TBdiabetes comorbidity is lacking.…”

A Systematic Review and Meta-Analysis on Catastrophic Cost incurred by Tuberculosis Patients and their Households

“…On the other hand, there were two studies not mentioned the tool used [29], [45]. The percent of patients facing catastrophic cost at cut off point 20% ranged from 4% in study of Mihir et al, study [46], to 87% in study of Wang et al, [44]. Regarding the percent of MDR-TB patients that facing catastrophic cost, they ranged from (68%), reported by Mullerpattan 2019 to (90%), reported by Collin et al, 2018 however DS-TB patients ranged from 24%, in the study of Gadallah,2018 to 42%, in the study of Rebecca L.Walctt, 2020.…”

Cost-Effectiveness of a Shorter Four-Month Tuberculosis Treatment Regimen in India

“…Therefore, the societal perspective was considered to account for the cost incurred by the TB patients for availing treatment services in public health facilities in the form of direct and indirect non-medical costs. The costs for food, 18 travel, 19 attendees 20 during treatment were considered as direct non-medical costs and loss of income 21 was considered as indirect non-medical costs. All these costs were collected from different independent studies conducted in India.…”