Risk factors for catastrophic costs associated with tuberculosis in rural South Africa

Abstract

SETTING: Fifty-five public clinics in northern South Africa. OBJECTIVE: To estimate patient costs and identify the factors associated with catastrophic costs among individuals treated for tuberculosis (TB). DESIGN: We performed cross-sectional interviews of consecutive patients at public clinics from October 2017 to January 2018. ‘Catastrophic costs’ were defined as costs totalling ≥20% of annual household income. For participants with no reported income, we considered scenarios where costs were considered non-catastrophic if 1) costs totaled <US$7.70 (ZAR100) or 2) a multidimensional poverty index was above a certain threshold. RESULTS: Among 327 participants, the estimated mean TB episode costs were US$365 (95%CI 233–498): out of-pocket costs comprised 58% of costs, wages lost due to health care-seeking represented 26%, and income reduction accounted for 16% of costs. Ninety (28%) participants experienced catastrophic costs, which were associated with clinic travel times of 60–90 min (adjusted prevalence ratio [aPR] 1.7, 95%CI 0.9–3.1), unemployment (aPR 2.0, 95%CI 1.0–4.0) and having fewer household members (aPR 0.6, 95%CI 0.3–1.0). CONCLUSIONS: In rural South Africa, catastrophic costs from TB are common and associated with distance to clinics, unemployment, and household size. These findings can help tailor social protection programs and enhance service delivery to patients at greatest risk of experiencing financial hardship.

Analysis of the economic burden of diagnosis and treatment on patients with tuberculosis in Bao’an district of Shenzhen City, China

“…TB is a well-known poverty-related disease, usually related to the disadvantages of socio-economic status. In particular, among those who come from rural and poor districts, the scarcity of health resources and poor economic condition place them in a more serious situation [5]. Delayed and repeated visits to clinics before diagnosis, the over-prescribing of drugs, and prolonged treatment are common [6].…”

The catastrophic cost of tuberculosis: advancing research and solutions

“…1 Two recent papers from the same study contribute important evidence in this area. 2,3 In Limpopo Province in South Africa, 28% of 323 adult TB patients experienced catastrophic costs. 2 Applying a different measurement method revealed high rates of deprivation (33%) among patients and higher TB episode costs in patients from deprived households.…”

“…2,3 In Limpopo Province in South Africa, 28% of 323 adult TB patients experienced catastrophic costs. 2 Applying a different measurement method revealed high rates of deprivation (33%) among patients and higher TB episode costs in patients from deprived households. 3 Erlinger et al's study confirms the burden imposed by TB on already vulnerable individuals and households.…”

“…In this context, Stracker et al acknowledge the role of social protection in addressing TB-related catastrophic costs. 2,3 The South African disability grant is designed as a form of social protection for people being treated for TB, and in one qualitative study, the grant provided a buffer against absolute poverty during TB treatment. 6 However, as pointed out by Stracker et al, only 5% of people being treated for TB in South Africa are reported to have access to the local Disability Grant despite eligibility.…”

“…6 However, as pointed out by Stracker et al, only 5% of people being treated for TB in South Africa are reported to have access to the local Disability Grant despite eligibility. 2 Poor access to locally available social protection schemes is both a missed opportunity and a largely unexplored area of research. Despite our consolidated understanding of how financially disastrous it is to experience TB, we still know far less about how social protection schemes could be made accessible to TB patients, or how these could be designed or adapted to best meet the needs of households living with or at risk of TB.…”