The catastrophic cost of tuberculosis: advancing research and solutions

Boccia, Delia; Bond, Virginia

doi:10.5588/ijtld.19.0521

Cited by 10 publications

(8 citation statements)

References 4 publications

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“…26,27 It is important to explore whether these programs can help patients avoid catastrophic costs and future socio-economic repercussions after treatment. 28 Given the large number of tuberculosis survivors alive today, our results highlight several areas of research importance for understanding the long-term impact that tuberculosis exerts on these survivors. Post-tuberculosis structural lung pathology and respiratory morbidity remain poorly defined and understood.…”

Section: Discussionmentioning

confidence: 86%

Quantifying the global number of tuberculosis survivors: a modelling study

Dodd

Yuen

Jayasooriya

et al. 2021

The Lancet Infectious Diseases

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BackgroundPeople who survive tuberculosis continue to experience clinical and societal consequences after recovery, including increased risks of recurrent tuberculosis, premature death, reduced lung function, and ongoing stigma. We aimed to describe the magnitude of this issue by estimating the number of tuberculosis survivors, who could be amenable to intervention. MethodsWe estimated the number of people who developed tuberculosis during 1980-2019 and survived until 2020. Numbers surviving treatment were based on country-level data on tuberculosis case notifications reported to the World Health Organization (WHO), excluding people who died during treatment. Numbers surviving untreated tuberculosis were based on the difference between WHO country-level incidence estimates and notifications, with published age-and HIV-stratified case fatality ratios applied. Post-tuberculosis life tables were developed for each country-year, using United Nations World Population Prospects 2019 mortality rates and published post-tuberculosis mortality hazard ratios. FindingsBetween 1980 and 2019 we estimate that 363 (95% uncertainty interval [UI] 287 -438) million people developed tuberculosis, of whom 172 (95%UI 169 -174) million were treated. Individuals who developed tuberculosis since 1980 experienced a total of 3.5 (95%UI 3.0 -3.9) billion life-years post-tuberculosis, with survivors of paediatric tuberculosis contributing 12% (95%UI 7 -17%) of these life-years. We estimate that 155 (95%UI 138 -171) million tuberculosis survivors were alive in 2020. The South-East Asia region had the largest proportion of tuberculosis survivors (47%). We estimate that 27 (95%UI 26 -29) million tuberculosis survivors alive in 2020 were treated within the past 5 years. InterpretationThe number of tuberculosis survivors alive today is over ten times the estimated annual tuberculosis incidence. Interventions to alleviate respiratory morbidity, screen for and prevent recurrent tuberculosis, and reduce stigma should be immediately prioritised for recently treated tuberculosis survivors.

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Section: Discussionmentioning

confidence: 86%

Quantifying the global number of tuberculosis survivors: a modelling study

Dodd

Yuen

Jayasooriya

et al. 2021

The Lancet Infectious Diseases

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“…Economically and socially vulnerable persons are at higher risk of TB infection and progression to active TB disease [2][3][4]. Previous research has also shown that TB exacerbates poverty [5][6][7]. Thus, one of the three targets included in the WHO End TB Strategy is the elimination of catastrophic costs, defined as incurring expenses in excess of 20 % of annual household income, due to TB [8].…”

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confidence: 99%

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

Vo¹,

Forse

Codlin³

et al. 2021

BMC Health Serv Res

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Background Many tuberculosis (TB) patients incur catastrophic costs. Active case finding (ACF) may have socio-protective properties that could contribute to the WHO End TB Strategy target of zero TB-affected families suffering catastrophic costs, but available evidence remains limited. This study measured catastrophic cost incurrence and socioeconomic impact of an episode of TB and compared those socioeconomic burdens in patients detected by ACF versus passive case finding (PCF). Methods This cross-sectional study fielded a longitudinal adaptation of the WHO TB patient cost survey alongside an ACF intervention from March 2018 to March 2019. The study was conducted in six intervention (ACF) districts and six comparison (PCF) districts of Ho Chi Minh City, Viet Nam. Fifty-two TB patients detected through ACF and 46 TB patients in the PCF cohort were surveyed within two weeks of treatment initiation, at the end of the intensive phase of treatment, and after treatment concluded. The survey measured income, direct and indirect costs, and socioeconomic impact based on which we calculated catastrophic cost as the primary outcome. Local currency was converted into US$ using the average exchange rates reported by OANDA for the study period (VNĐ1 = US$0.0000436, 2018–2019). We fitted logistic regressions for comparisons between the ACF and PCF cohorts as the primary exposures and used generalized estimating equations to adjust for autocorrelation. Results ACF patients were poorer than PCF patients (multidimensional poverty ratio: 16 % vs. 7 %; p = 0.033), but incurred lower median pre-treatment costs (US$18 vs. US$80; p < 0.001) and lower median total costs (US$279 vs. US$894; p < 0.001). Fewer ACF patients incurred catastrophic costs (15 % vs. 30 %) and had lower odds of catastrophic cost (aOR = 0.17; 95 % CI: [0.05, 0.67]; p = 0.011), especially during the intensive phase (OR = 0.32; 95 % CI: [0.12, 0.90]; p = 0.030). ACF patient experienced less social exclusion (OR = 0.41; 95 % CI: [0.18, 0.91]; p = 0.030), but more often resorted to financial coping mechanisms (OR = 5.12; 95 % CI: [1.73, 15.14]; p = 0.003). Conclusions ACF can be effective in reaching vulnerable populations and mitigating the socioeconomic burden of TB, and can contribute to achieving the WHO End TB Strategy goals. Nevertheless, as TB remains a catastrophic life event, social protection efforts must extend beyond ACF.

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“…Poor access, despite eligibility for social protection is a missed opportunity to improve the socio-economic situation of DR-TB affected households. (37,38) For better coverage, beneficiaries need to be linked to social protection more effectively. (39) This study is strengthened by the fact that it was conducted under routine programme conditions.…”

Section: Discussionmentioning

confidence: 99%

“…(5,7) The pooled average of catastrophic costs, i.e. TB-related costs exceeding 20% of a household's annual income prior to TB was estimated globally at 43% (95% CI: [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] among TB affected households. (8) This is much higher than the End TB strategy milestone of zero catastrophic cost by 2020.…”

Section: Introductionmentioning

confidence: 99%

Coverage and effectiveness of conditional cash transfer for people with drug resistant tuberculosis in Zimbabwe: a mixed methods study

Timire

Sandy

Ferrand

et al. 2022

Preprint

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Background The End TB strategy recommends social protection to mitigate socio-economic impacts of tuberculosis. Zimbabwe started implementing a conditional cash transfer (CCT) programme for people on drug resistant tuberculosis (DR-TB) treatment in 2013. We aimed to determine the proportion of people receiving CCT and effectiveness of CCT in improving treatment outcomes, explore their experiences with registering for CCT and understand the impact of CCT from the perspective of beneficiaries. Methods Data from 2014-2021 were extracted from TB registers and CCT payment records within the National TB Programme. Sixteen in-depth interviews were conducted with people who were completing treatment or had completed treatment within two months. Poisson regression, adjusted for province, year of treatment, age and sex was used to investigate associations between receiving CCT and successful treatment outcomes among people who were in DR-TB care for at least 3 months after treatment initiation. Qualitative data were analyzed using thematic analysis. Results A total of 481 people were included in the quantitative study. Of these, 53% (254/481) received CCT at some point during treatment. People who exited DR-TB care within three months were 73% less likely to receive CCT than those who did not (prevalence ratio (PR)=0.27 [95%CI: 0.18-0.41]). Among those who were alive and in care three months after treatment initiation, CCT recipients were 32% more likely to have successful outcomes than those who did not (adjusted PR=1.32, [95%CI: 1.00-1.75]). Qualitative results revealed lack of knowledge about availability of CCT among people with DR-TB and missed opportunities by healthcare providers to provide information about availability of CCT. Delays and inconsistencies in disbursements of CCT were frequent themes. Conclusion CCT were associated with successful treatment outcomes. Improvements in coverage, timeliness and predictability of disbursements are recommended.

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The catastrophic cost of tuberculosis: advancing research and solutions

Cited by 10 publications

References 4 publications

Quantifying the global number of tuberculosis survivors: a modelling study

Quantifying the global number of tuberculosis survivors: a modelling study

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

Coverage and effectiveness of conditional cash transfer for people with drug resistant tuberculosis in Zimbabwe: a mixed methods study

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