Free tuberculosis diagnosis and treatment are not enough: patient cost evidence from three continents

Mauch, Verena; Bonsu, Frank; Gyapong, Margaret; Awini, Elizabeth; Suarez, Pedro; Marcelino, Belkys; Melgen, Ricardo Elías; Lönnroth, Knut; Nhung, Nguyen Viet; Hoa, Nguyen Binh; Klinkenberg, Eveline

doi:10.5588/ijtld.12.0368

Cited by 105 publications

(118 citation statements)

References 13 publications

(18 reference statements)

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“…The comparison group included patients from the same month and from the marginalised/vulnerable populations of the same area as the Axshya SAMVAD patients. Second, similar to Mauch et al and Morishita et al [11,23], we included a nationally representative sample, the reference population for which was limited to the Axshya districts ( n = 285). The findings are also representative of their respective reference populations with potential contaminated exposures excluded.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, we identified many studies in the recent period that determined catastrophic costs due to TB care (diagnosis and treatment), but did not provide data specifically for diagnosis [11,33–36]. A systematic review from Africa (studies from 1990 to 2010) revealed that the pre-diagnostic costs for TB varied between 10.4 and 35% of pre-TB AHI [12].…”

Section: Discussionmentioning

confidence: 99%

“…As TB services are integrated with the general health system, the geographical, financial and social access barriers to TB care are similar to the barriers of accessing the general health system [4,13]. Patients get trapped in a vicious circle of repeated visits to the same health care provider (HCP) or visits to multiple HCPs including private and traditional HCPs [8,10,11,14,15]. …”

Section: Introductionmentioning

confidence: 99%

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Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Shewade

Gupta

Satyanarayana

et al. 2018

Global Health Action

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Background: There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. Objectives: To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). Methods: In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as ‘catastrophic’ if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. Results: When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US$ 4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF [−0.15 (−0.32, 0.11)] and PCF [−0.06 (−0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [−0.60 (−0.81, –0.39)] and PCF [−0.58 (−0.78, –0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles. Conclusion: ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Shewade

Gupta

Satyanarayana

et al. 2018

Global Health Action

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“…Often conditionality is attached to receiving the transfer, such as regular attendance of medical appointments. While many developed and developing country governments provide such transfers, the World Food Programme is probably the single biggest global provider, having reached 360,000 TB patients and their household members through its food assistance 4 programmes in over ten countries in 2012. In the top ten countries alone, 91,000 index clients were reached while support was also given to an additional 248,000 household members.…”

mentioning

confidence: 99%

Is There a Need to Mitigate the Social and Financial Consequences of Tuberculosis at the Individual and Household Level?

et al. 2014

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This paper reviews evidence on social and economic costs of tuberculosis. Key socio-economic consequences include stigma, social isolation, increased outof-pocket expenditures for medical and non-medical costs and reduced income. Many of the financing methods that households use have long-term negative impacts and the poor are most vulnerable to these costs. Together, these negative consequences adversely affect TB control, in terms of delayed diagnosis, delayed initiation of treatment, suboptimal adherence and failure to complete treatment, as well as the coping and well being of the individual and household. There are two ways to reduce treatment costs for the patient; one can either reduce the direct and indirect costs of seeking a diagnosis and obtaining treatment and/or provide income transfers to offset some of those costs incurred. Social transfers in the form of food, cash or vouchers can mitigate the negative effects by enabling the individual to seek a diagnosis, protecting minimum food expenditures, reducing the need to accumulate debt and reduce productive assets and reducing the negative impacts on other household members, particularly young children and school-age children.

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“…Bebanan kewangan dan ekonomi ini dilihat menyukarkan mereka mendapatkan rawatan tuberkulosis dan mengakibatkan pesakit-pesakit ini tidak menghabiskan rawatan (Sagbakken et al 2008;Wynne et al 2014). Kajian analisis kos terbaru yang dijalankan di tiga buah negara iaitu Ghana, Vietnam, dan Republik Dominican turut mengesahkan bahawa rawatan dan diagnosis tuberkulosis percuma adalah tidak mencukupi dibuktikan dengan fakta masih terdapat 27.0% hingga 70.0% daripada pesakit-pesakit dalam kajian tersebut terpaksa berhenti kerja dan mengalami kurang pendapatan sehingga memaksa mereka menjual harta dan meminjam wang akibat daripada penyakit tuberkulosis yang dihidapi (Mauch et al 2013).…”

Section: Perbincanganunclassified

Faktor Penghalang dan Penggalak Kepatuhan daripada Perspektif Pesakit Tuberkulosis Cicir Rawatan di Kuala Lumpur

Shariff

Shah

Kamaludin

2017

JSKM

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Free tuberculosis diagnosis and treatment are not enough: patient cost evidence from three continents

Abstract: We observed similar patterns and challenges of TB-related costs for patients across the three countries. We advocate for global, united action for TB patients to be included under social protection schemes and for national TB programmes to improve equitable access to care.

Cited by 105 publications

References 13 publications

Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Is There a Need to Mitigate the Social and Financial Consequences of Tuberculosis at the Individual and Household Level?

Faktor Penghalang dan Penggalak Kepatuhan daripada Perspektif Pesakit Tuberkulosis Cicir Rawatan di Kuala Lumpur

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