Economic burden of tuberculosis in Tanzania: a national survey of costs faced by tuberculosis-affected households

Abstract

Background Although tuberculosis (TB) care is free in Tanzania, TB-associated costs may compromise access to services and treatment adherence resulting in poor outcomes and increased risk of transmission in the community. TB can impact economically patients and their households. We assessed the economic burden of TB on patients and their households in Tanzania and identified cost drivers to inform policies and programs for potential interventions to mitigate costs. Methods We conducted a nationally representative cross-sectional survey using a standard methodology recommended by World Health Organization. TB patients of all ages and with all types of TB from 30 clusters across Tanzania were interviewed during July – September 2019. We used the human capital approach to assess the indirect costs and a threshold of 20% of the household annual expenditure to determine the proportion of TB-affected households experiencing catastrophic cost. We descriptively analyzed the cost data and fitted multivariable logistic regression models to identify potential predictors of catastrophic costs. Results Of the 777 TB-affected households, 44.9% faced catastrophic costs due to TB. This proportion was higher (80.0%) among households of patients with multi-drug resistant TB (MDR-TB). Overall, cost was driven by income loss while accessing TB services (33.7%), nutritional supplements (32.6%), and medical costs (15.1%). Most income loss was associated with hospitalization and time for picking up TB drugs. Most TB patients (85.9%) reported worsening financial situations due to TB, and over fifty percent (53.0%) borrowed money or sold assets to finance TB treatment. In multivariable analysis, the factors associated with catastrophic costs included hospitalization (adjusted odds ratio [aOR] = 34.9; 95% confidence interval (CI):12.5–146.17), living in semi-urban (aOR = 1.6; 95% CI:1.0–2.5) or rural areas (aOR = 2.6; 95% CI:1.8–3.7), having MDR-TB (aOR = 3.4; 95% CI:1.2–10.9), and facility-based directly-observed treatment (DOT) (aOR = 7.2; 95% CI:2.4–26.6). Conclusion We found that the cost of TB care is catastrophic for almost half of the TB-affected households in Tanzania; our findings support the results from other surveys recently conducted in sub-Saharan Africa. Collaborative efforts across health, employment and social welfare sectors are imperative to minimize household costs due to TB disease and improve access to care, patient adherence and outcomes.

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

“…Hospitalization was reported to be a significant predictor by investigators in other studies from Kenya, China, and Tanzania. 15,16,20,21 15,16,20,21 However, hospitalization was found not significantly associated with total costs as well as costs for drug-resistant TB in studies from Indonesia and China. 10,12 Patients lose wages and incur costs for transportation, food, and accommodation during the days of hospitalization.…”

“…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.…”

“…[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. We conducted this study to determine the predictors of catastrophic costs of TB among patients with TB-HIV co-infection and TB-diabetes comorbidity.…”

Duration of Symptoms Prior to Pediatric and Adolescent Tuberculosis Diagnosis and Its Impact on Schooling in Tanzania: A Mixed Methods Study

“…10 Furthermore, many households in Tanzania report barriers to accessing care for children despite exposure to household members with TB. A recent survey by Kilale et al 20 reported a median cost of 154.90 US dollars incurred by patients in Tanzania while seeking services along the TB care cascade. This survey identified nutritional supplements and transportation as the highest cost categories, but importantly did not assess the cost of screening additional household TB contacts or the downstream financial implications of lost learning.…”

Implementing tuberculosis patient cost surveys in resource-constrained settings: lessons from Tanzania

“…As such, the Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC), in collaboration with the National Institute for Medical Research (NIMR), World Health Organization (WHO), and the U.S. Centers for Disease Control and Prevention (CDC) conducted a TB Patient Cost survey in Tanzania to evaluate the costs incurred by patients and their households before and after diagnosis of TB. The study methods and results are available elsewhere [ 12 ]. This was the first survey in Tanzania to derive baseline information and experience for subsequent surveys to be conducted regularly.…”