Out-of-Pocket Costs for Patients Diagnosed with Tuberculosis in Different Healthcare Settings in Bandung, Indonesia

McAllister, Susan; Lestari, Bony Wiem; Sullivan, Trudy; Hadisoemarto, Panji Fortuna; Afifah, Nur; Apip, Rosye Arosdiani; Murray, Megan; Hill, Philip C.; Alisjahbana, Bachti

doi:10.4269/ajtmh.19-0848

Cited by 13 publications

(16 citation statements)

References 17 publications

(34 reference statements)

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“…Despite yielding the comparative performance as Xpert by the combination of three oral swab specimens, this raises concerns about rising out-of-pocket costs for TB patients, especially patients in underdeveloped regions. 18 Further information is essential to inform the policy maker to formulate appropriate financial support strategy for incorporation OS-LAMP into the routine diagnostic algorithm.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Yield of Oral Swab Testing by TB-LAMP for Diagnosis of Pulmonary Tuberculosis

Song¹,

Ma²,

Liu³

et al. 2021

IDR

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A prospective study was conducted to ascertain the accuracy of oral swab specimens collected in the early morning, spot and at night for detecting pulmonary tuberculosis (TB). Methods: We prospectively enrolled patients with symptoms suggestive of pulmonary TB in Beijing Chest Hospital. An early morning sputum specimen was collected from each patient for GeneXpert MTB/RIF (Xpert) and mycobacterial culture. In addition, three oral swabs were collected for TB-LAMP testing. Results: With the combined results of three oral swab specimens, the proportion of Mycobacterium tuberculosis (MTB)-positive cases achieved 40.6%, which was comparable to results for Xpert and MGIT (P=0.603). Using Xpert plus MGIT as reference, the sensitivity of OS-LAMP on a single specimen ranged from 32.6% on the night oral swab to 50.0% on the morning swab. The combination of three oral swab specimens correctly identified 38 MTB-positive cases, indicating an overall sensitivity of 82.6%, which was significantly higher than that of a single oral swab specimen (P<0.001, P=0.001). Conclusion: Oral swab can be used as an alternative specimen for diagnosis of pulmonary TB using TB-LAMP. Morning oral swab exhibits the highest sensitivity, and the inclusion of more specimens at different time points provides compensation in diagnostic sensitivity with single oral swab.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Yield of Oral Swab Testing by TB-LAMP for Diagnosis of Pulmonary Tuberculosis

Song¹,

Ma²,

Liu³

et al. 2021

IDR

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“…Delay to diagnosis and treatment of TB can contribute to late presentation, more severe disease, ongoing transmission of M. tuberculosis , and increased out-of-pocket costs [6 , 7] . Delay can be classified as patient delay or health system delay.…”

Section: Introductionmentioning

confidence: 99%

Patient pathways and delays to diagnosis and treatment of tuberculosis in an urban setting in Indonesia

Lestari

McAllister

Hadisoemarto

et al. 2020

The Lancet Regional Health - Western Pacific

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Background: Understanding patient pathways can help align patient preferences and tuberculosis (TB) related services. We investigated patient pathways, and diagnostic and treatment delays among TB patients in Indonesia, which has one of the highest proportions of non-notified TB cases globally. Methods: We conducted a study of TB patients recruited from Community Health Centers (CHCs), public and private hospitals, and private practitioners from 2017 to 2019 in Bandung City, regarding general characteristics and symptoms, and health-seeking, diagnostic and treatment pathways. Findings: We recruited 414 TB patients: 138 (33%) in CHCs, 210 (51%) in hospitals, 66 (20%) in private practitioners. Most patients (74 •6%) first sought care at an informal or private provider and experienced a complex pathway visiting both public and private providers to obtain a diagnosis. The median number of health provider visits pre-diagnosis was 6 (IQR 4-8). From start of symptoms, it took a median 30 days (IQR 14-61) to present to a health provider, 62 days to reach a TB diagnosis, and 65 days (IQR 37-119) to start treatment. Patient delay was longer among male, lowly-educated and uninsured individuals. There were longer diagnostic delays among uninsured individuals, those who initially visited private providers, and those with multiple visits prior to diagnosis. Longer treatment delays were found in those with multiple pre-diagnosis visits or diagnosed by private practitioners. Interpretation: Patient pathways in Indonesia are complex, involving the public and private sector, with multiple visits and long delays, especially to diagnosis. A widely available accurate diagnostic test for TB could have a dramatic effect on reducing delays, onward transmission and mortality.

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“…Paper quality was very good in one study 38 and good in thirteen studies 6 , 18 , 19 , 31 – 34 , 36 , 37 , 41 , 42 , 44 , 45 . Fourteen studies were of satisfactory quality 14 – 17 , 20 , 35 , 39 , 40 , 43 , 45 – 48 , 50 and one was unsatisfactory 49 (Table 1 ).…”

Section: Resultsmentioning

confidence: 96%

A systematic review and meta-analysis of the catastrophic costs incurred by tuberculosis patients

Ghazy

Saeh

Abdelmoneim

et al. 2022

Sci Rep

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One of the strategies of the World Health Organization End Tuberculosis (TB) was to reduce the catastrophic costs incurred by TB-affected families to 0% by 2020.Catastrophic cost is defined by the total cost related to TB management exceeding 20% of the annual pre-TB household income. This study aimed to estimate the pooled proportion of TB affected households who incurred catastrophic costs. We searched PubMed, SciELO, Scopus, Embase, Google Scholar, ProQuest, SAGE, and Web of Science databases according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines till November 20, 2020. Eligible studies were identified and data on catastrophic costs due to TB were extracted. We performed a meta-analysis to generate the pooled proportion of patients with TB facing catastrophic costs. From 5114 studies identified, 29 articles were included in the final analysis. The pooled proportion of patients faced catastrophic costs was (43%, 95% CI [34–51]). Meta-regression revealed that country, drug sensitivity, and Human immune-deficiency Virus (HIV) co-infection were the main predictors of such costs. Catastrophic costs incurred by drug sensitive, drug resistant, and HIV co-infection were 32%, 81%, and 81%, respectively. The catastrophic costs incurred were lower among active than passive case findings (12% vs. 30%). Half (50%) of TB-affected households faced catastrophic health expenditure at 10% cut-off point. The financial burden of patients seeking TB diagnosis and treatment continues to be a worldwide impediment. Therefore, the End TB approach should rely on socioeconomic support and cost-cutting initiatives.PROSPERO registration: CRD42020221283.

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Out-of-Pocket Costs for Patients Diagnosed with Tuberculosis in Different Healthcare Settings in Bandung, Indonesia

Cited by 13 publications

References 17 publications

Diagnostic Yield of Oral Swab Testing by TB-LAMP for Diagnosis of Pulmonary Tuberculosis

Diagnostic Yield of Oral Swab Testing by TB-LAMP for Diagnosis of Pulmonary Tuberculosis

Patient pathways and delays to diagnosis and treatment of tuberculosis in an urban setting in Indonesia

A systematic review and meta-analysis of the catastrophic costs incurred by tuberculosis patients

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