Factors Influencing Hospitalization Rates and Inpatient Cost of Patients with Tuberculosis in Jiangsu Province, China: An Uncontrolled before and after Study

Abstract

Objective: The China Center for Disease Control and Prevention (CDC) introduced an innovative financing model of tuberculosis (TB) care and control with the aim of standardizing TB treatment and reducing the financial burden associated with patients with TB. This is a study of the pilot implementation of new financing mechanism in Zhenjiang, between 2014–2015. We compared TB hospitalization rates and inpatient service costs before and after implementation to examine the factors associated with hospital admissions. Our goal is to provide evidence-based recommendations for improving TB service provision and cost control. Methods: We reviewed new policy documents on TB financing. We conducted a patient survey to investigate the utilization of inpatient services, and patients’ out-of-pocket payment for inpatient care. We extracted total medical expenditures of inpatient services from inpatient records of TB designated hospitals. Findings: 63.6% (n = 159) of the surveyed patients with TB were admitted for treatment in 2015, which was higher than that in 2013 (54.8%, n = 144). The number of hospital admission was slightly lower in 2015 (1.16 per patient) than in 2013 (1.26 per patient), while the length of hospital stay was longer in 2015 (24 days) than in 2013 (16 days). In 2015, patients from families with low incomes were more likely to be admitted than those from higher income groups (OR = 3.06, 95% CI: 1.12–8.33). The average inpatient service cost in 2015 (3345 USD) was 1.7 times the cost in 2013 (1952 USD). It was found that 96.2% of patients with TB who were from low-income households spent more than 20% of their household income on inpatient care in 2013, versus 100% in 2015. Conclusion: The TB hospital admission rate and total inpatient service cost increased over the study period. The majority of patients with TB, particularly poor patient who used inpatient care, continue to suffer from heavy financial burden.

Analysis of the economic burden of diagnosis and treatment on patients with tuberculosis in Bao’an district of Shenzhen City, China

“…Over a quarter of patients reported that the economic burden of cure was heavy. Some authors have concluded that total costs due to TB care account for a higher percentage of their annual income [13,[16][17][18]. Direct costs were still substantial, of which non-TB drugs and auxiliary examinations were the most significant cost items [19][20][21].…”

Reported high in hospital mortality among adult tuberculosis patients admitted to university of Gondar hospital, North-West Ethiopia

“…1,2,14 The in-hospital mortality rate of TB patients in this study was 30%, which was higher than that of the 14% mortality rate in Saudi Arabia and Israel, as well as the 20.73%, 10% and 23% mortality rates in Japan, Papua New Guinea and Pakistan, respectively. 6,[15][16][17][18] The disparities in death rates across these nations may be attributable to variances in patient groups investigated, which may be impacted by socioeconomic characteristics, health care quality and coverage, and the burden of TB. On the other hand, a study from Brazil reported a mortality rate of 31.8%, which was complementary to our study, and a higher mortality rate of 37.5% was observed from study from the Philippines, as both the Philippines, Brazil, as well as Ethiopia are among the 30 high TB burden countries.…”

“…2,4 A meta-analysis and systematic review of ten studies indicated that estimated in-hospital mortality ranged from 2% to 12%, while a Chinese retrospective cohort study of TB patients hospitalized for acute care found that 90-day all-cause death was 13.8%. [4][5][6] Similarly, a research conducted in Saudi Arabia revealed a 14% mortality rate after a mean stay of 1.87 months. 7 A 5-year retrospective study of Kenyan TB surveillance data found an overall 5.5% patient death rate; a mortality rate of 12.2 deaths per 100 person-years (PY), with the mortality rate increasing from 7.8 in 2012 to 17.7 in 2016.…”

Tuberculosis disease characteristics associated with mortality, severe morbidity and unsuccessful treatment in people living with HIV treated for tuberculosis – a secondary analysis of the ANRS 12300 Reflate TB2 trial

“…Most studies evaluating risk factors associated with TB mortality, severe morbidity or unsuccessful treatment in PLWH typically focus on factors related to the host, such as male sex (17)(18)(19)(20)(21), advanced age (8,12,17,20,(22)(23)(24)(25), co-morbidities (8, 23,24,[26][27][28][29][30][31][32][33][34][35], poor adherence to treatment (24,32,36,37), smoking (26,38), alcohol use (29,31,32) or low socio-economic level (38,39). Very few studies focused on important characteristics of the TB disease itself such as bacillary load (8,22,40), extent of lung involvement on chest x-ray (36, [41][42][43], or disease dissemination (17,44,45).…”