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

Yixiang Huang,Weiqing Chen,Jianying Huang,Xiaoting Su,Jianwei Guo,Lingling Zhang,Liang Chen,Hemant Deepak Shewade

doi:10.1371/journal.pone.0237865

Abstract

Illness-related costs experienced by tuberculosis patients produce a severe economic impact on households, especially poor families. Few studies have investigated the full costs, including direct and indirect costs, at the patient and household levels in south-east China. A case follow-up study was conducted in the Bao'an district of Shenzhen City, China. Eligible new and previously treated individuals with pulmonary tuberculosis (TB) during January 1st 2013 to June 30th 2013 were enrolled. Medical and non-medical costs as well as income loss were calculated in diagnosis and treatment periods, respectively. Factors associated with costs due to TB diagnosis, treatment and TB care (diagnosis + treatment) were explored respectively with a linear regression model. Of the total 514 TB patients enrolled, 95% were from the migrant population, and 65% were males, with a mean age of 32.25 (±10.11). The median costs due to TB diagnosis and TB treatment were 79 United States dollar (USD), 748USD (6.2897 China Yuan (CNY) = 1USD, 2013) per patient, respectively. The median costs due to TB care (diagnosis and treatment) per patient was 1218USD, corresponding to 26% of patients' annual income pre-illness. Those who visited more times to health facilities, hospitalized, received higher education, or occupied in national civil servant/services/retired staff might expense more before diagnosis. Costs due to TB treatment was significantly higher among migrant patients, sputum smear positive patients, and widowed/divorced population. Factors associated with less total costs were native patients, fewer times of visiting to health-care facilities and those with no hospitalization history due to TB. Although a free TB control policy is in force, patients with TB are still facing a heavy economic burden. More available interventions to reduce the financial burden on tuberculosis patients are urgently needed.

Highlights

Illness-related costs experienced by tuberculosis patients produce a severe economic impact on households, especially poor families
The median costs due to TB diagnosis and TB treatment were 79 United States dollar (USD), 748USD (6.2897 China Yuan (CNY) = 1USD, 2013) per patient, respectively
More available interventions to reduce the financial burden on tuberculosis patients are urgently needed

Summary

Introduction

Illness-related costs experienced by tuberculosis patients produce a severe economic impact on households, especially poor families. Since 1990, the World Health Organization(WHO)-recommended directly observed treatment + short course chemotherapy (DOTS) strategy has been implemented by the Chinese government under the National Tuberculosis Control Program to control this epidemic [2]. Many investigators have pointed out that both the TB patients and their households bear a heavy economic burden under the free DOTS control strategy [3, 4]. TB is a well-known poverty-related disease, usually related to the disadvantages of socio-economic status. 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]. Patients bear too much economic burden which precludes them from further adhering to treatment and results in treatment failure [4]

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Discussion

Conclusion