Catastrophic total costs due to tuberculosis among affected households in Uganda; prevalence, drivers and policy implications

Abstract

Introduction: Tuberculosis (TB) patients often incur catastrophic costs related to illness, as well as to seeking and receiving health care. Such costs can create access and adherence barriers which can affect health outcomes and increase risk of transmission of disease. While out-of-pocket medical expenditures are important, lost income is often the dominant contributor to economic hardship. We assessed the prevalence and drivers of catastrophic total costs (indirect and direct combined) due to TB in Uganda. Methods: We interviewed 1,181 participants with TB using a validated WHO TB “patient cost tool” to collect data on patients’ demographics, household income, direct medical and non-medical costs and the indirect costs of seeking TB treatment. We analyzed catastrophic total costs due to TB as total costs exceeding 20% of the household’s annual income. Logistic regression was used to identify the drivers of catastrophic total costs. Results: Average total costs were USD 243 (118.43-483.48), with direct non-medical costs contributing up to 42%. The proportion of patients’ households experiencing catastrophic total costs was 53.1%; with 65.4% and 46.4% the poorest and richest household respectively. The main drivers of catastrophic total costs were; poor household (aOR 24; CI 13.2,43.8), MDR-TB (aOR 7.56; CI 2.92, 19.58), delay in seeking treatment (aOR 1.1; CI 0.7, 1.8) and male gender (aOR 1.1; CI 0.7, 1.3). Conclusions: Free TB care and treatment is not enough to prevent households from incurring catastrophic total costs due to TB. Social protection policies and programs designed to reduce poverty and vulnerability among TB patients are urgently needed.