Abstract
SETTING: Eight tuberculosis treatment sites in Cavite Province, the Philippines, including two sites specialising in management of multidrug-resistant tuberculosis (MDR-TB).OBJECTIVE: To evaluate costs incurred by TB patients and to determine the proportion of households that faced catastrophic costs, then to consider cost survey responses alongside results of detailed patient-pathway modelling.DESIGN: Clustered cross-sectional survey using a field testing version of the WHO TB patient-costing tool and protocol; face-to-face interviews with 194 patients conducted in May-August 2016. Costs included direct-medical, direct non-medical and indirect costs using the human capital approach. Patients were deemed to incur catastrophic expenditure if TB-related costs exceeded 20% of annual household income. Patient pathways were modelled following multiple health staff interviews.RESULTS: Estimated mean cost incurred by patients with drug-susceptible TB was US$321 vs. $2356 for MDR-TB patients. Catastrophic costs were suffered by 28% of drug-susceptible and 80% of MDR-TB patients, with lost income being the largest contributor. Patient-pathway modelling suggested most patients had under-reported health visits.CONCLUSION: Survey results indicate that patient costs are large for all patients in Cavite, particularly for MDR-TB patients. Patient-pathway modelling suggests these costs are an underestimate due to poor recollection of health visits, suggesting that the WHO instrument and protocol could be improved to better capture the diagnostic journey.
Highlights
TUBERCULOSIS (TB) IS CLOSELY associated with poverty: populations with few resources and poor access to healthcare face the greatest burden.[1]
TB drugs are typically available to patients without charge, patients often incur numerous costs on the care pathway: direct out-of-pocket costs for medical expenses, transport, temporary accommodation and food, and indirect costs due to lost income
Patient-costs were greater for multidrug-resistant tuberculosis (MDR-TB) patients than drug-susceptible TB (DS-TB) patients, the largest cost-component being lost-income (59% and 41%, respectively). Those without catastrophic expenditure had lost a smaller proportion of income, suggesting that reducing or reimbursing income-loss could reduce the likelihood of costs becoming catastrophic
Summary
TUBERCULOSIS (TB) IS CLOSELY associated with poverty: populations with few resources and poor access to healthcare face the greatest burden.[1]. High patient costs place an immense burden on household-finances,[2] become an obstacle to accessing treatment[3] and are a factor in treatment noncompletion.[4,5] When considering TB interventions, an understanding of the size, origins and drivers of these costs should be considered alongside other evidence in decision-making
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