Abstract
BackgroundIllness-related costs incurred by patients constitute a severe economic burden for households especially in low-income countries. High household costs of illness lead to impoverishment; they impair affordability and equitable access to health care and consequently hamper tuberculosis (TB) control. So far, no study has investigated patient costs of TB in the former Soviet Union.MethodsAll adult new pulmonary TB cases enrolled into the DOTS program in 12 study districts during the study period were enrolled. Medical and non-medical expenditure as well as loss of income were quantified in two interviews covering separate time periods. Costs of different items were summed up to calculate total costs. For missing values, multiple imputation was applied.ResultsA cohort of 204 patients under DOTS, 114 men and 90 women, participated in the questionnaire survey. Total illness costs of a TB episode averaged $1053 (c. $4900 purchasing power parity, PPP), of which $292, $338 and $422 were encountered before the start of treatment, during intensive phase and in continuation phase, respectively. Costs per month were highest before the start of treatment ($145) and during intensive phase ($153) and lower during continuation phase ($95). These differences were highly significant (paired t-test, p < 0.0005 for both comparisons).ConclusionsThe illness-related costs of an episode of TB exceed the per capita GDP of $1600 PPP about two-and-a-half times. Hence, these costs are catastrophic for concerned households and suggest a high risk for impoverishment. Costs are not equally spread over time, but peak in early stages of treatment, exacerbating the problem of affordability. Mitigation strategies are needed in order to control TB in Tajikistan and may include social support to the patients as well as changes in the management of TB cases. These mitigation strategies should be timed early in treatment when the cost burden is highest.
Highlights
Illness-related costs incurred by patients constitute a severe economic burden for households especially in low-income countries
One of the first studies to comprehensively measure household costs found that the costs of an episode of TB in Thailand amounted to 20% of annual household income in the poorest third of patients and were devastating [12]
While a considerable part of the scientific discussion on household costs has concentrated on the period before diagnosis [15,16,17], this study found that costs during treatment account for three quarters of total costs-in a setting with free TB drugs
Summary
Illness-related costs incurred by patients constitute a severe economic burden for households especially in low-income countries. High household costs of illness lead to impoverishment; they impair affordability and equitable access to health care and hamper tuberculosis (TB) control. There have been many studies on cost-effectiveness of different TB control strategies, mainly investigating the costs to the health system. When studying the economic impact on households, this strategy may be tempting, based on the rationale that TB treatment should be free of charge afterwards. Those studies that measured costs after enrolment in TB control programs invariably found considerable costs during treatment [1,12,13,14]. To our knowledge so far no study looked at the distribution of household costs of TB over time other than differentiating before diagnosis and after diagnosis
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