Economic burden of multidrug-resistant tuberculosis: a multicenter study across Vietnamese regions

Nam, Viet; Nhung, Nguyen Viet; Hoa, N. B.; Thủy, Hoàng Thị Thanh; Phương, Nguyễn Thụy; Anh, Nguyen Thu; Anh, Luu Tuan; Vo, Trung Quang; Ha, Thuy Van; Meeyai, Aronrag; Thavorncharoensap, Montarat; Chaikledkaew, Usa

doi:10.5588/ijtld.18.0039

Cited by 8 publications

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“…[ 24 ] In terms of cost components, direct medical costs accounted for the highest proportion of total costs in our study, which is consistent with result from Viet Nam. [ 25 ] Cost of drugs was an important driver of direct medical costs shown by a systematic review of financial burden for TB, [ 5 ] which agrees with our finding. The proportion of indirect cost ranked the second of total costs in our study, which is similar to other countries such as Fiji, Ghana and Philippines.…”

Section: Discussionsupporting

confidence: 89%

Household financial burden among multidrug-resistant tuberculosis patients in Guizhou province, China

et al. 2020

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Multidrug-resistant tuberculosis (MDR-TB) threatens global public health. Poor access to health care due to financial hardship contributes to further transmission of the disease. The study aimed to: quantify the magnitude of financial burden among affected households by MDR-TB in the first year of treatment; measure financial and social protection of local policies for MDR-TB by catastrophic payments; determine associated factors of catastrophic payments in Guizhou, China. A cross-sectional study was conducted in 2 hospitals designated for MDR-TB from January to August 2018. Data were collected by interviewing eligible MDR-TB outpatients and reviewing the medical records. The magnitude of financial burden was documented by total cost and distribution of cost components. Catastrophic payments were measured by 2 indicators: catastrophic health expenditure (CHE) and catastrophic total costs (CTC), both of which were estimated by incidence and intensity. Their associated factors were determined using logistic regression models. Of 161 households affected by MDR-TB, the average total costs due to MDR-TB treatment in the first year was US$ 8266 and consisted of 72% direct medical costs, 5% direct non-medical costs and 23% indirect costs (income loss). Thirty seven percent of direct medical costs were covered by insurance. Overall, the incidence of CHE and CTC was 68.3% and 87.0%, respectively. Both incidence and intensity for the 2 defined catastrophic costs increased when a households income decreased. Five significant factors of catastrophic costs were low household income, absence of students in a family, hospital length of stay, male gender, and job/productivity loss. Households with MDR-TB patients shouldered a high financial burden which was mainly driven by direct medical costs and income loss in Guizhou. Greater catastrophic payments were associated with hospital length of stay and socioeconomic status, especially had a dose-response relationship with households income. Our findings suggest that financial and social protection of local policies for MDR-TB should be improved by preparing a uniform and comprehensive insurance package to cover sufficiently direct medical costs, and introducing social pro-poor assistance policies for risk families to protect them from financial hardship.

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Section: Discussionsupporting

confidence: 89%

Household financial burden among multidrug-resistant tuberculosis patients in Guizhou province, China

et al. 2020

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“…This may be a reflection of the higher risk of loss to follow-up among male patients, which in turn may be related to the financial burden associated with MDR-TB treatment. Catastrophic treatment-related costs borne by the household have been shown to be a significant barrier to treatment success [ 5 , 21 , 22 ]. In cases where male patients are the primary breadwinner, loss of employment or time away from work during treatment can result in considerable income reduction, placing financial strain on a patient’s household.…”

Section: Discussionmentioning

confidence: 99%

Predictors of treatment outcomes among patients with multidrug-resistant tuberculosis in Vietnam: a retrospective cohort study

Wrohan

Nguyen

et al. 2022

BMC Infect Dis

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Background Improving treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) is a leading priority for global TB control. This retrospective cohort study evaluated the factors associated with treatment success among patients treated for MDR-TB in two provinces in Vietnam. Methods Treatment outcomes were evaluated for adult patients treated in Hanoi and Thanh Hoa provinces between 2014 and 2016. The primary outcome was the proportion of patients with treatment success, defined as cure or treatment completion. Logistic regression analysis was used to evaluate the relationship between patient clinical and microbiological characteristics and treatment success. Results Treatment outcomes were reported in 612 of 662 patients; of these, 401 (65.5)% were successfully treated. The odds of treatment success were lower for male patients (aOR 0.56, 95% CI 0.34–0.90), for people living with HIV (aOR 0.44, 95% CI 0.20–1.00), and for patients treated for extensive antibiotic resistance (pre-XDR-/XDT-TB) (aOR 0.53, 95% CI 0.29–0.97), compared with others. Patients who achieved culture conversion in the first 4 months of treatment had increased odds (aOR 2.93, 95% CI 1.33–6.45) of treatment success. In addition, loss to follow-up was less common among patients covered by social health insurance compared to those who paid for treatment out-of-pocket (aOR 0.55, 95% CI 0.32–0.95). Conclusions Among patients with MDR-TB, males, people living with HIV, and those with more extensive antibiotic resistance at diagnosis are at greatest risk of an unsuccessful treatment outcome. Efforts to optimise the management of co-morbidities (such as HIV), ensure rapid bacteriological conversion, and provide financial support for patients promise to improve treatment outcomes.

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“…Aside from the national TB patient cost surveys, there is a limited number of published studies on this topic. A small number of studies have been published from China, Vietnam, and Cambodia [11,12,13,14,15,16,17,18]. Another paper from Australia reported on dissemination of vouchers in times of financial distress [19].…”

Section: Costs Of Tb Care In the Western Pacific Regionmentioning

confidence: 99%

“…A qualitative study from Vietnam found that indirect costs related to cumbersome diagnostic pathways and directly observed treatment in the public sector was an important reason for patients to instead seek care in the private sector despite higher direct medical costs there [20]. In another study from Vietnam, the authors used a cross-sectional survey design and interviewed 2014 MDR-TB patients from three tertiary care hospitals across Vietnam [13]. The authors found that the average cost of treatment for MDR-TB was US $1480.34 (± US $211.61) and US $2695.58 (± US $294.98) for patients receiving the 9- and 20-month MDR-TB treatment regimens, respectively [13].…”

Section: Costs Of Tb Care In the Western Pacific Regionmentioning

confidence: 99%

“…In another study from Vietnam, the authors used a cross-sectional survey design and interviewed 2014 MDR-TB patients from three tertiary care hospitals across Vietnam [13]. The authors found that the average cost of treatment for MDR-TB was US $1480.34 (± US $211.61) and US $2695.58 (± US $294.98) for patients receiving the 9- and 20-month MDR-TB treatment regimens, respectively [13]. Direct medical costs comprised the highest proportion of overall costs, with medicines accounting for a large proportion of these medical costs [13].…”

Section: Costs Of Tb Care In the Western Pacific Regionmentioning

confidence: 99%

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The Financial Burden of Tuberculosis for Patients in the Western-Pacific Region

et al. 2019

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The End Tuberculosis (TB) Strategy has the ambitious goal of ending the global TB epidemic by the year 2030, which is aligned to the Sustainable Development Goals. One of three high level indicators of the Strategy is the “catastrophic costs” indicator, which aims to determine the proportion of TB-affected households that incur TB-care related costs equivalent to 20% or more of their annual household income. The target is that zero percentage of TB-affected households will incur catastrophic costs related to TB care by the year 2020. In the Western Pacific Region of the World Health Organization, it is a priority to determine the financial burden of TB and then act to mitigate it. To date, eight countries in the Region have conducted nationally representative TB patient cost surveys to determine the costs of TB care. The results from four countries that have completed these surveys (i.e., Fiji, Mongolia, the Philippines, and Vietnam) indicate that between 35% and 70% of TB patients face catastrophic costs related to their TB care. With these results in mind, significant additional efforts are needed to ensure financial risk protection for TB patients, expand Universal Health Coverage, and improve access to social protection interventions. A multi-sectoral approach is necessary to achieve this ambitious goal by the year 2020.

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Economic burden of multidrug-resistant tuberculosis: a multicenter study across Vietnamese regions

Abstract: There was a significant difference in total costs among the three hospitals in the 9- and 20-month treatment groups.

Cited by 8 publications

References 0 publications

Household financial burden among multidrug-resistant tuberculosis patients in Guizhou province, China

Household financial burden among multidrug-resistant tuberculosis patients in Guizhou province, China

Predictors of treatment outcomes among patients with multidrug-resistant tuberculosis in Vietnam: a retrospective cohort study

The Financial Burden of Tuberculosis for Patients in the Western-Pacific Region

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