Out-of-Pocket Expenditures, Indirect Costs and Health-Related Quality of Life of Patients with Pulmonary Tuberculosis in Thailand

Abstract

BackgroundThailand’s hospitals may adopt different supervision approaches to improve tuberculosis (TB) treatment adherence.ObjectiveThe aim of this study was to compare out-of-pocket (OOP) expenditures, indirect costs, and health-related quality of life (HRQoL) among TB patients who received pharmaceutical care (pharmacist-led patient education and telephone consultation), home visit, and self-administered therapy (SAT) in Thailand.MethodsWe conducted a prospective study to collect OOP expenditures, indirect costs, and HRQoL from a subsample of 104 adult pulmonary TB patients who started treatment between January and May 2014 in three hospitals. The three sources of data included patient interviews, patient medical records, and the hospital billing database. Patients were followed from January 2014 to March 2015. Relevant OOP expenditures collected during the interviews included (1) healthcare costs and other medications costs (e.g. vitamins, antibiotics, anti-cough) occurring in private healthcare units; and (2) costs of transportation, food, and accommodation. Productivity loss was measured using the self-reported amount of time a patient was unable to work due to TB, travel time to and from the hospital, time spent at the hospital (waiting time, consultation time, and hospitalizations), and time spent accompanying family members on outpatient visits or during hospitalizations. Cost differences among treatment strategies were adjusted for baseline characteristics by generalized linear models (GLMs). All costs were converted to international dollars (I$).ResultsA total of 256 eligible patients who started pulmonary TB treatment during the specified period were approached, with 104 patients being included in the analysis (29, 38, and 37 patients receiving pharmaceutical care, home visit, and SAT, respectively). Mean OOP expenditures per patient receiving pharmaceutical care, home visit, and SAT were I$907.56 [confidence interval (CI) I$603.80–I$1269.41], I$148.47 (CI I$109.49–I$194.89), and I$95.35 (CI I$69.11–I$129.63), respectively. The GLM indicated statistically significantly lower OOP expenditures for patients receiving either home visit or SAT (ratio of mean costs 0.247, CI 0.142–0.427; and 0.318, CI 0.187–0.540, respectively) than those receiving pharmaceutical care. Patient’s indirect costs for receiving pharmaceutical care, home visit, and SAT were I$1925.68 (CI I$922.06–I$3284.94), I$2393.66 (CI I$1435.01–I$3501.98), and I$833.33 (CI I$453.87–I$1263.45), respectively. The GLM found no statistically significant differences in indirect costs for the home visit and SAT groups (ratio of mean costs 1.904, CI 0.754–4.802; and 0.792, CI 0.289–2.175, respectively) when pharmaceutical care was set as the reference. Mean utility scores [EuroQol five-dimensional three-level (EQ-5D-3L)] at baseline and treatment end were 0.679 and 0.830, 0.713 and 0.905, and 0.708 and 0.913 for patients receiving pharmaceutical care, home visit, and SAT, respectively.ConclusionPharmaceutical care patients experienced the highest OO...

Assessing the influencing factors of out-of-pocket costs on tuberculosis in Sichuan Province: a cross-sectional study

“…Compared with illiterate patients, the economic costs of patients in junior high school were higher. When patients receive only junior middle school education, they will be more aware of seeing a doctor and pay more attention to health than illiterate patients [ 45 ]. However, compared with patients with higher education, patients with junior middle school education may not better understand hospital procedures and medical knowledge [ 46 ].…”

Estimating the pre- and post-diagnosis costs of tuberculosis for adults in Pakistan: household economic impact and costs mitigating strategies

“…The indirect costs could be due to absenteeism from work and loss of productivity and income while suffering because of long course of disease and recovery pathway. Among Thai adults, a study reported that patients experienced highest indirect costs out of total expenditure due to the patients’ reduced ability to work and loss of income [ 24 ]. The policy implication to curb the higher indirect costs and loss of income might be an assistance of TB patients with leave compensation with introducing a paid sick leave package along with the flexibility in working hours.…”

Clinical pharmacy services for tuberculosis management: a systematic review

“…Six studies originated from high-TB-burden countries, including four from India (Bhardwaja et al, 2012;Venkatapraveen et al, 2012;Thomas et al, 2018;Narayana et al, 2020), one from China (Tang et al, 2018), and one from Indonesia (Karuniawati et al, 2019). Others were from different regions: Thailand (Tanvejsilp et al, 2018), Ivory Coast (Abrogoua et al, 2016), Türkiye (Clark et al, 2007), andBrazil (Lopes et al, 2017). The earliest included study was published in 2007.…”

“…Notably, among the 10 studies, no randomized controlled studies were identified. Study designs were heterogeneous and included five prospective cohort studies (50%) (Bhardwaja et al, 2012;Venkatapraveen et al, 2012;Lopes et al, 2017;Tanvejsilp et al, 2018;Thomas et al, 2018), two case-control studies (20%) (Clark et al, 2007;Tang et al, 2018), two quasi-experimental studies (with and without control) (Karuniawati et al, 2019;Narayana et al, 2020), and a cross-sectional study (Abrogoua et al, 2016). Most studies were prospective; for only one study, this was unknown (Abrogoua et al, 2016).…”

“…Of the 10 studies included in the review, clinical data sources used for clinical pharmacy services were varied; seven studies used adherence measuring tools (70%) (Clark et al, 2007;Bhardwaja et al, 2012;Venkatapraveen et al, 2012;Tang et al, 2018;Thomas et al, 2018;Karuniawati et al, 2019;Narayana et al, 2020), six used medical records (60%) (Clark et al, 2007;Bhardwaja et al, 2012;Abrogoua et al, 2016;Tang et al, 2018;Tanvejsilp et al, 2018;Thomas et al, 2018), five used patient interviews (50%) (Clark et al, 2007;Bhardwaja et al, 2012;Lopes et al, 2017;Tanvejsilp et al, 2018;Thomas et al, 2018), and four used laboratory testing/ therapeutic drug monitoring (40%) (Clark et al, 2007;Venkatapraveen et al, 2012;Tang et al, 2018;Thomas et al, 2018), amongst others. The intervention focus provided within the clinical pharmacy services was medication adherence, defined as the voluntary cooperation of the patient in taking the drugs or medicine as prescribed (DEPICT, 2013), in five studies (50%) (Clark et al, 2007;Bhardwaja et al, 2012;Tang et al, 2018;Thomas et al, 2018;Karuniawati et al, 2019); medication safety in four studies (40%) (Clark et al, 2007;Abrogoua et al, 2016;Lopes et al, 2017;Tang et al, 2018); education of patients/caregivers regarding the needs/beliefs in three studies (30%) (Venkatapraveen et al, 2012;Thomas et al, 2018;Narayana et al, 2020...…”