How much do Indians pay for tuberculosis treatment? A cost analysis

Abstract

Setting: India’s National Tuberculosis Elimination Programme (NTEP) covers diagnostic and therapeutic costs of TB treatment. However, persons living with TB (PLWTB) continue to experience financial distress due to direct costs (payment for testing, treatment, travel, hospitalization, and nutritional supplements) and indirect costs (lost wages, loan interest, and cost of domestic helpers).Objective: To analyze the magnitude and pattern of TB-related costs from the perspective of Indian PLWTB.Design: We identified relevant articles using key search terms (‘tuberculosis,’ ‘India,’ ‘cost,’ ‘expenditures,’ ‘financing,’ ‘catastrophic’ and ‘out of pocket’) and calculated variance-weighted mean costs.Results: Indian patients incur substantial direct costs (mean: US$46.8). Mean indirect costs (US$666.6) constitute 93.4% of the net costs. Mean direct costs before diagnosis can be up to four-fold that of costs during treatment. Treatment in the private sector can result in costs up to six-fold higher than in government facilities. As many as one in three PLWTB in India experience catastrophic costs.Conclusion: PLWTB in India face high direct and indirect costs. Priority interventions to realize India’s goal of eliminating catastrophic costs from TB include decreasing diagnostic delays through active case finding, reducing the need for travel, improving awareness and perception of NTEP services, and ensuring sufficient reimbursement for inpatient TB care.

Expenditure Incurred by Patients of Pulmonary and Extrapulmonary Tuberculosis Under Revised National Tuberculosis Control Programme in District Tuberculosis Center, Jammu

“…23,24 Another cost analysis in India reiterated huge direct costs and indirect costs which corroborates with our findings. 25 However, in Brazil, cost per completed treatment was US$ 336 in DOT facilities. 26 The mean cost to pa-tients for pulmonary and extrapulmonary TB treatment was US$ 108.4 and US$ 328.0 respectively in 2010 in Yemen which is lower than our estimates.…”

Living with tuberculosis: a qualitative study of patients’ experiences with disease and treatment

“…Economic hardship was reported across all countries. TB is associated with economic vulnerability but can also drive families into poverty through loss of income, the costs of transportation and food supplements, and associated medical expenses [29][30][31][32][33][34][35][36]. Programs providing social protection to TB patients have been linked to improved outcomes and the increased uptake of preventive therapy but must be easily accessible [29,37,38].…”

The cost of pediatric abdominal tuberculosis treatment in India: Evidence from a teaching hospital

“…A systematic review of studies conducted in India found that the indirect costs for tuberculosis were higher compared to direct costs. The review reported that average direct costs range from $27 to $184 compared to $1 to $674 for indirect costs (US dollars) (Sinha et al, 2020). The difference in costs reported in the review and the current study can be because the review included studies with costs from many hospitals including public, private, or non-governmental organization-owned hospitals, which might have different costs compared to Christian Medical Hospital, Ludhiana (Sinha et al, 2020).…”

“…The review reported that average direct costs range from $27 to $184 compared to $1 to $674 for indirect costs (US dollars) (Sinha et al, 2020). The difference in costs reported in the review and the current study can be because the review included studies with costs from many hospitals including public, private, or non-governmental organization-owned hospitals, which might have different costs compared to Christian Medical Hospital, Ludhiana (Sinha et al, 2020). The direct cost of abdominal tuberculosis in the current study was $3095.00, which is much higher than the average cost of extra-pulmonary tuberculosis, $367 US dollars, from seven health facilities in Yemen using data collected from 2008 to 2009 (Othman et al, 2012).…”