Pre- and post-diagnosis costs of tuberculosis to patients on Directly Observed Treatment Short course in districts of southwestern Ethiopia: a longitudinal study
Tóm tắt
Financial burden on tuberculosis (TB) patients results in delayed treatment and poor compliance. We assessed pre- and post-diagnosis costs to TB patients. A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Direct out-of-pocket, payments, and lost income (indirect cost) were solicited from patients during the first 2 months and at the end of treatment. Thus, we ascertained direct medical, nonmedical, and indirect costs incurred by patients during pre- and post-diagnosis periods. We categorized costs incurred from onset of illness until TB diagnosis as pre-diagnosis and that incurred after diagnosis through treatment completion as post-diagnosis. Pre- and post-diagnosis costs constitute total cost incurred by the patients. We fitted linear regression model to identify predictors of cost. Between onset of illness and anti-TB treatment course, patients incurred a median (inter-quartile range (IQR)) of US$201.48 (136.7–318.94). Of the total cost, the indirect and direct costs respectively constituted 70.6 and 29.4%. TB patients incurred a median (IQR) of US$97.62 (6.43–184.22) and US$93.75 (56.91–141.54) during the pre- and post-diagnosis periods, respectively. Thus, patients incurred 53.6% of the total cost during the pre-diagnosis period. Direct out-of-pocket expenses during the pre- and post-diagnosis periods respectively amount to median (IQR) of US$21.64 (10.23–48.31) and US$35.02 (0–70.04). Patient delay days (p < 0.001), provider delay days (p < 0.001), number of healthcare facilities visited until TB diagnosis (p < 0.001), and TB diagnosis at private facilities (p = 0.02) independently predicted increased pre-diagnosis cost. Similarly, rural residence (p < 0.001), hospitalization during anti-TB treatment (p < 0.001), patient delay days (p < 0.001), and provider delay days (p < 0.001) predicted increased post-diagnosis costs. TB patients incur substantial cost for care seeking and treatment despite “free service” for TB. Therefore, promoting early care seeking, decentralizing efficient diagnosis, and treatment services within reach of peoples, and introducing reimbursement system for direct costs can help minimize financial burden to the patient.
Tài liệu tham khảo
World Health Organization. Global tuberculosis report. Switzerland: World Health Organization; 2016.
Laxminarayan R, Klein E, Dye C, Floyd K, Darley S, Adeyi O. Economic benefit of tuberculosis control. World Bank. 2007;
World Health Organization: An expanded DOTS framework for effective tuberculosis control. 2002.
World Health Organization. In: WHO, editor. The end TB strategy: global strategy and targets for tuberculosis prevention, care and control after 2015; 2015.
Tanimura T, Jaramillo E, Weil D, Raviglione M, Lonnroth K. Financial burden for tuberculosis patients in low- and middle-income countries: a systematic review. Eur Respir J. 2014;43(6):1763–75.
KNCV, WHO, JATA. The tool to estimate Patients’Costs. In: KNCV Tuberculosis Foundation, World Health Organization, Japan Anti-Tuberculosis Association; 2008.
Barter D, Agboola S, Murray M, Barnighausen T. Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa—a systematic review. BMC Public Health. 2012;12:980.
Ukwaja K, Alobu I, Lgwenyi C, Hopewell P. The high cost of free tuberculosis services: patient and household costs associated with tuberculosis care in Ebonyi State, Nigeria. PLoS One. 2013;8(8):e73134.
Othman G, Ibrahim M, Raja’a Y. Costs associated with tuberculosis diagnosis and treatment in Yemen for patients and public health services. Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit. 2012;18(4):393–8.
Aspler A, Menzies D, Oxlade O, Banda J, Mwenge L, Godfrey-Faussett P, Ayles H. Cost of tuberculosis diagnosis and treatment from the patient perspective in Lusaka, Zambia. Int J Tuberc Lung Dis. 2008;12(8):928–35.
Finnie R, Khoza L, Van den Borne MT, Abotchie P, Mullen P. Factors associated with patient and health care system delay in diagnosis and treatment for TB in sub-Saharan African countries with high burdens of TB and HIV. Tropical Med Int Health. 2011;16(4):394–411.
Wingfield T, Tovar M, Huff D, Boccia D, Saunders M, Datta S, Montoya R, Ramos E, Lewis J, Gilman R, et al. Beyond pills and tests: addressing the social determinants of tuberculosis. Clinical medicine. 2016;16 (Suppl 6):s79–91.
Long Q, Smith H, Zhang T, Tang S, Garner P. Patient medical costs for tuberculosis treatment and impact on adherence in China: a systematic review. BMC Public Health. 2011;11:393.
Faustini A, Hall J, Perucci A. Risk factors for multidrug resistant tuberculosis in Europe: a systematic review. Thorax. 2006;61:158–61.
Pooran A, Pieterson E, Davids M, Theron G, Dheda K. What is the cost of diagnosis and management of drug resistant tuberculosis in South Africa? PLoS One. 2013;8(1):e54587.
WHO. Global tuberculosis report. In: World Health Organization; 2015.
Federal Democratic Republic of Ethiopia Ministry of Health. Ethiopia’s Fourth National Health Accounts, 2007/08. Addis Ababa: Federal Democratic Republic of Ethiopia Ministry of Health; 2010.
Verguet S, Memirie S, Norheim O. Assessing the burden of medical impoverishment by cause: a systematic breakdown by disease in Ethiopia. BMC Med. 2016;14(1):164.
Mesfin M, Newell J, Madeley R, Mirzoev T, Tareke I, Kifle Y, Gessessew A, Walley J. Cost implications of delays to tuberculosis diagnosis among pulmonary tuberculosis patients in Ethiopia. BMC Public Health. 2010;10:173.
Datiko D, Lindtjorn B. Cost and cost-effectiveness of smear-positive tuberculosis treatment by Health Extension Workers in Southern Ethiopia: a community randomized trial. PLoS One. 2010;5(2):e9158.
Federal Minstry of Health of Ethiopia. Guidelines for clinical and programmatic management of TB, leprosy and TB/HIV in Ethiopia. 5th ed. Addis Ababa: Ethiopian Federal Minstry of Health; 2012.
Federal Democratic Republic of Ethiopia Central Statistical Agency. Population projection of Ethiopia for all regions at Wereda level from 2014–2017. Addis Ababa: Central Statistical Authority; 2013.
Southern Nation Nationalities Peoples Region Health Bureau. Annual performance report. Hawassa: SNNPR HB; 2014.
World Health Organization. Treatment of tuberculosis: guidelines. Geneva: World Health Organization; 2010.
WHO. Guide to identifying the economic consequences of disease and injury. Geneva; 2009.
National Bank of Ethiopia. Inter-bank daily foreign exchange rate in (USD)—archive. In: National Bank of Ethiopia; 2015.
Virenfeldt J, Rudolf F, Camara C, Furtado A, Gomes V, Aaby P, Petersen E, Wejse C. Treatment delay affects clinical severity of tuberculosis: a longitudinal cohort study. BMJ Open. 2014;4(6):e004818.
Belkina T, Khojiev D, Tillyashaykhov M, Tigay Z, Kudenov M, Tebbens J, Vlcek J. Delay in the diagnosis and treatment of pulmonary tuberculosis in Uzbekistan: a cross-sectional study. BMC Infect Dis. 2014;14:624.
Laokri S, Amoussouhui A, Ouendo E, Hounnankan A, Anagonou S, Gninafon M, Kassa F, Tawo L, Dujardin B. A care pathway analysis of tuberculosis patients in Benin: highlights on direct costs and critical stages for an evidence-based decision-making. PLoS One. 2014;9(5):e96912.
Lambert M, Delgado R, Michaux G, Volz A, Speybroeck N, Van Der Stuyft P. Delays to treatment and out-of-pocket medical expenditure for tuberculosis patients, in an urban area of South America. Ann Trop Med Parasitol. 2005;99(8):781–7.
Yimer S, Hansen C, Bjune G. The perspective of private practitioners regarding tuberculosis case detection and treatment delay in Amhara region, Ethiopia: a cross-sectional study. BMC Res Notes. 2011;4:285.
Ukwaja K, Alobu I, Abimbola S, Hopewell P. Household catastrophic payments for tuberculosis care in Nigeria: incidence, determinants, and policy implications for universal health coverage. Infectious Disease of Poverty. 2013;2(1):21.