First national tuberculosis patient cost survey in Lao People’s Democratic Republic: Assessment of the financial burden faced by TB-affected households and the comparisons by drug-resistance and HIV status

Abstract

Background Tuberculosis (TB) patients incur large costs for care seeking, diagnosis, and treatment. To understand the magnitude of this financial burden and its main cost drivers, the Lao People’s Democratic Republic (PDR) National TB Programme carried out the first national TB patient cost survey in 2018–2019. Method A facility-based cross-sectional survey was conducted based on a nationally representative sample of TB patients from public health facilities across 12 provinces. A total of 848 TB patients including 30 drug resistant (DR)-TB and 123 TB-HIV coinfected patients were interviewed using a standardised questionnaire developed by the World Health Organization. Information on direct medical, direct non-medical and indirect costs, as well as coping mechanisms was collected. We estimated the percentage of TB-affected households facing catastrophic costs, which was defined as total TB-related costs accounting for more than 20% of annual household income. Result The median total cost of TB care was US$ 755 (Interquartile range 351–1,454). The costs were driven by direct non-medical costs (46.6%) and income loss (37.6%). Nutritional supplements accounted for 74.7% of direct non-medical costs. Half of the patients used savings, borrowed money or sold household assets to cope with TB. The proportion of unemployment more than doubled from 16.8% to 35.4% during the TB episode, especially among those working in the informal sector. Of all participants, 62.6% of TB-affected households faced catastrophic costs. This proportion was higher among households with DR-TB (86.7%) and TB-HIV coinfected patients (81.1%). Conclusion In Lao PDR, TB patients and their households faced a substantial financial burden due to TB, despite the availability of free TB services in public health facilities. As direct non-medical and indirect costs were major cost drivers, providing free TB services is not enough to ease this financial burden. Expansion of existing social protection schemes to accommodate the needs of TB patients is necessary.

A Systematic Review and Meta-Analysis on Catastrophic Cost Incurred by Tuberculosis Patients

“…The proportion of the mean direct cost to the mean total cost at 20% addressed in 7 studies, ranged from 26% in Chittamany, 2020 [33] to 93% in Yang, 2020 [32]. Low proportions were observed in Fuady, 2018 [41], Tomeny, 2020 [15], and Collins Timire, 2020 [47] with proportion of 32%, 34% and 49% respectively, while high proportion also reported in Muttamba, 2020 [30], with 66% and in Nhung, 2018 [37] with 68%.…”

“…[29], to 1178 [30]. The tool used for estimation of the cost survey were either WHO TB cost survey tool, [5], [15], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40] & [44], or adapted WHO tool to Indonesian context [12] & [41], or structured questionnaire [17], [26], [42], [43], pre-coded interview scheduled [18],or tool of stop TB partnership, [13], [27], [28],or headcount tool [44], or Lumley T. survey [14], or TB coalition tool [16]. On the other hand, there were two studies not mentioned the tool used [29], [45].…”

“…Hardship nancing was discussed only in two studies [14] [45]. Seven studies discussed coping cost [16], [27], [30], [33], [35], [37] & [45]. Regarding the quality score, it was ranged from (3-unsatisfactory) [29] to (9-Very good) [34].…”

“…Regarding the quality score, it was ranged from (3-unsatisfactory) [29] to (9-Very good) [34]. The Good score ranged from 7 to 8 pints, was among thirteen studies [5], [16], [17], [26], [28], [31], [32], [33], [37], [38], [39], [41] & [45]. While Satisfactory score which ranged from 5 to 6 points, was illustrated in the remaining fourteen studies, [12], [13], [14], [15], [18], [27], [30], [35], [36], [40], [42], [43], [44] & [45].…”

“…The proportion of the mean direct cost to the mean total cost addressed in 2 studies. Don Mudzengi , 2017[16] and his team showed that the proportion of mean direct cost to the mean total cost was 30% among HIV and TB co-infection patients, while a higher proportion reported in Chittamany, 2020 [33] with 59%. As we couldn't pool the study because of the high un-explained heterogeneity.…”