Abstract
Background: This is the first survey to use the World Health Organization (WHO) methodology to document the magnitude and main drivers of tuberculosis (TB) patient costs in order to guide policies on cost mitigation and to produce a baseline measure for the percentage of TB-affected households experiencing catastrophic costs in Myanmar. Methods: A nationally representative cross-sectional survey was administered to 1000 TB patients in health facilities from December 2015 to February 2016, focusing on costs of TB treatment (direct and indirect), household income, and coping strategies. A total cost was estimated for each household by extrapolating reported costs and comparing them to household income. If the proportion of total costs exceeded 20% of the annual household income, a TB-affected household was deemed to have faced catastrophic costs. Results: 60% of TB-affected households faced catastrophic costs in Myanmar. On average, total costs were USD 759, and the largest proportion of this total was accounted for by patient time (USD 365), followed by food costs (USD 200), and medical expenses (USD 130). Low household wealth quintile and undergoing MDR-TB treatment were both significant predictors for households facing catastrophic costs. Conclusions: The high proportion of TB-affected households experiencing catastrophic costs suggests the need for TB-specific social protection programs in patient-centered healthcare. The survey findings have led the government and donors to increase support for MDR-TB patients. The significant proportion of total spending attributable to lost income and food or nutritional supplements suggests that income replacement programs and/or food packages may ameliorate the burdensome costs.
Highlights
Tuberculosis (TB) kills approximately 1.5 million people per year [1]
In many countries TB diagnostic tests and drug treatment are provided for free, this has been shown to be insufficient in protecting TB-affected households economic burden [3]
The definition of whether a household had incurred catastrophic costs was if the total costs were more than 20% of the total household income
Summary
Tuberculosis (TB) kills approximately 1.5 million people per year [1]. Beyond being the greatest infectious disease killer, TB often inflicts significant social and economic costs on affected households. In many countries TB diagnostic tests and drug treatment are provided for free, this has been shown to be insufficient in protecting TB-affected households economic burden [3] One reason for this is that TB costs go beyond direct health expenditure, and include payments for transport, accommodation, and food expenses, as well as income loss from illness and care-seeking. Failure to reduce these economic barriers can mean access to care is inhibited, diagnosis and treatment are delayed or foregone, and TB transmission in the community is exacerbated. The significant proportion of total spending attributable to lost income and food or nutritional supplements suggests that income replacement programs and/or food packages may ameliorate the burdensome costs
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