How to reduce household costs for people with tuberculosis: a longitudinal costing survey in Nepal

Abstract

The aim of this study was to compare costs and socio-economic impact of tuberculosis (TB) for patients diagnosed through active (ACF) and passive case finding (PCF) in Nepal. A longitudinal costing survey was conducted in four districts of Nepal from April 2018 to October 2019. Costs were collected using the WHO TB Patient Costs Survey at three time points: intensive phase of treatment, continuation phase of treatment and at treatment completion. Direct and indirect costs and socio-economic impact (poverty headcount, employment status and coping strategies) were evaluated throughout the treatment. Prevalence of catastrophic costs was estimated using the WHO threshold. Logistic regression and generalized estimating equation were used to evaluate risk of incurring high costs, catastrophic costs and socio-economic impact of TB over time. A total of 111 ACF and 110 PCF patients were included. ACF patients were more likely to have no education (75% vs 57%, P = 0.006) and informal employment (42% vs 24%, P = 0.005) Compared with the PCF group, ACF patients incurred lower costs during the pretreatment period (mean total cost: US$55 vs US$87, P < 0.001) and during the pretreatment plus treatment periods (mean total direct costs: US$72 vs US$101, P < 0.001). Socio-economic impact was severe for both groups throughout the whole treatment, with 32% of households incurring catastrophic costs. Catastrophic costs were associated with ‘no education’ status [odds ratio = 2.53(95% confidence interval = 1.16–5.50)]. There is a severe and sustained socio-economic impact of TB on affected households in Nepal. The community-based ACF approach mitigated costs and reached the most vulnerable patients. Alongside ACF, social protection policies must be extended to achieve the zero catastrophic costs milestone of the End TB strategy.

Dissaving In the Era of “Free” Care for Tuberculosis (TB): A Qualitative Exploration of Financial Coping and Enablers Among Patients with Co-Prevalent TB-HIV/ TB-Diabetes in Bhavnagar Region, Western India

“…The coping strategies like borrowing money, selling assets, and mortgaging household assets were also reported to be employed by patients with TB in India, Myanmar, Soloman Islands, Nepal, Malawi, Tajikistan, Benin, Ghana, China, South Africa, Bangladesh, and Tanzania. 5,[7][8][9][10][11][12][13][14][15][16][17][18] Our findings are also similar to the coping strategies described among patients with TB-diabetes comorbidity 19 , and TB-HIV co-infection. 20 Our study findings on enabling factors were supported by several other studies.…”

“…Studies have reported various negative financial coping strategies such as borrowing money, selling assets such as jewellery, interrupting school, and others. 3,5,[7][8][9][10][11][12][13][14][15][16][17][18] Such financial coping strategies are even considered a proxy indicator of catastrophic costs employed by patients with TB. 17 Further, dissaving serves as an indicator of the financial protection mechanisms employed by governments to help them balance such costs.…”

Socio-protective effects of active case finding on catastrophic costs from tuberculosis in Ho Chi Minh City, Viet Nam: a longitudinal patient cost survey

“…Based on these epidemiologic benefits, the NTP has placed a strong emphasis on ACF in the recent past [14][15][16][17]. However, to date the evidence on the socio-protective nature of ACF remains limited [18,19] with none available for the Vietnamese context.…”

Comparative Yield of Tuberculosis during Active Case Finding Using GeneXpert or Smear Microscopy for Diagnostic Testing in Nepal: A Cross-Sectional Study

“…Nevertheless, it is important to conduct such camps as the study screened and tested a large number of people who are not able to access diagnosis in other ways. Such strategies improve equity of access to quality TB services, reduce patient incurred costs from TB illness in the most impoverished population groups, and are essential to “leave no-one behind” in countries with large remote rural populations [ 19 , 20 ].…”