Abstract
Background TB diagnostic and treatment services in India are provided free of cost in the programmatic context across the country. There are different costs incurred during health care utilization, and this study was conducted to estimate such costs. Methodology. A longitudinal study was conducted among patients of three urban tuberculosis units (TUs) of Davangere, Belagavi, and Bengaluru, Karnataka. Trained data collectors administered a validated questionnaire and recorded monthly costs incurred by the patients which are expressed in median Indian National Rupees (INR). The analysis was done using SPSS version 23.0. A p value of <0.05 was taken as statistically significant. Results Among 214 patients, about 37%, 42%, and 21% belonged to Davangere, Belagavi, and Bengaluru, respectively. Median total pre- and postdiagnostic costs incurred across the three TUs were 3800 and 4000 INR, respectively. The direct nonmedical cost was higher for accommodation (median cost of 800 INR) and direct medical cost for non-TB drugs (median cost of 2000 INR). However, maximum direct medical and nonmedical costs were attributed to hospital admissions (1200 INR) and accommodation costs (700 INR) in the postdiagnostic period, respectively. The median indirect cost incurred was 300 INR overall, and the maximum total indirect cost was 40000 INR in the postdiagnostic period. About one-third of patients faced loss of income and 19.6% faced coping costs. Patients spent about 6.7% (0.97%–52.3%) of their income on TB treatment. About 12.3% patients faced catastrophic expenditure. Median cost was significantly higher among those seeking private health care facilities (12100 INR in private vs. 6800 INR in public; p < 0.05) during the prediagnostic period. Prediagnostic and diagnostic out-of-pocket expenditures (OPE) were significantly higher across all the three centres (p < 0.05). Conclusion The TB patients experienced untoward expenditure under programmatic settings. The costs encountered by one in eight patients were catastrophic by nature.
Highlights
Tuberculosis (TB) ranks among the top ten causes of death worldwide and is the leading cause from a single infectious agent
Davangere district has one urban tuberculosis units (TUs) catering to a 0.45 million population, Belagavi district has one urban TU catering to a 0.52 million population, and Bengaluru urban district has 14 urban TUs catering to a 5.4 million population
A total of 214 patients were enrolled for the study, of which, 37% (79), 42% (90), and 21% (45) were from the TUs of the Davangere, Belagavi, and Bengaluru districts, respectively
Summary
Tuberculosis (TB) ranks among the top ten causes of death worldwide and is the leading cause from a single infectious agent. The total default rate and death rate have decreased to 7% and 6% in 2015 despite the high HIV-TB burden, respectively. A longitudinal study was conducted among patients of three urban tuberculosis units (TUs) of Davangere, Belagavi, and Bengaluru, Karnataka. Median total pre- and postdiagnostic costs incurred across the three TUs were 3800 and 4000 INR, respectively. Maximum direct medical and nonmedical costs were attributed to hospital admissions (1200 INR) and accommodation costs (700 INR) in the postdiagnostic period, respectively. The median indirect cost incurred was 300 INR overall, and the maximum total indirect cost was 40000 INR in the postdiagnostic period. Median cost was significantly higher among those seeking private health care facilities (12100 INR in private vs 6800 INR in public; p < 0:05) during the prediagnostic period. The costs encountered by one in eight patients were catastrophic by nature
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