The Financial Burden of Tuberculosis for Patients in the Western-Pacific Region.

Kerri Viney,Tauhidul Islam,Fukushi Morishita,Knut Lönnroth,Nguyen Binh Hoa

doi:10.3390/tropicalmed4020094

Abstract

The End Tuberculosis (TB) Strategy has the ambitious goal of ending the global TB epidemic by the year 2030, which is aligned to the Sustainable Development Goals. One of three high level indicators of the Strategy is the “catastrophic costs” indicator, which aims to determine the proportion of TB-affected households that incur TB-care related costs equivalent to 20% or more of their annual household income. The target is that zero percentage of TB-affected households will incur catastrophic costs related to TB care by the year 2020. In the Western Pacific Region of the World Health Organization, it is a priority to determine the financial burden of TB and then act to mitigate it. To date, eight countries in the Region have conducted nationally representative TB patient cost surveys to determine the costs of TB care. The results from four countries that have completed these surveys (i.e., Fiji, Mongolia, the Philippines, and Vietnam) indicate that between 35% and 70% of TB patients face catastrophic costs related to their TB care. With these results in mind, significant additional efforts are needed to ensure financial risk protection for TB patients, expand Universal Health Coverage, and improve access to social protection interventions. A multi-sectoral approach is necessary to achieve this ambitious goal by the year 2020.

Highlights

The End Tuberculosis (TB) Strategy has the ambitious goal of ending the global TB epidemic by the year 2030, which is aligned to the Sustainable Development Goals (SDGs) [1]
Of these three indicators, estimated TB incidence and mortality have been reported by the World Health Organization (WHO) on an annual basis since 1997 [2]. The third of these indicators is the newly defined “catastrophic costs” indicator, which was included in the End TB Strategy in recognition of the fact that the financial barriers to TB care are substantial and will likely impede achievement of global TB elimination goals [1]. The choice of this indicator as one of three high level indicators in the End TB Strategy acknowledges that the global epidemiological targets of reductions in mortality and incidence cannot be achieved without major progress towards Universal Health Coverage (UHC) and expanded access to social protection [1]
The End TB Strategy has an ambitious target that zero TB affected families will face catastrophic costs related to their TB care, to be achieved by the year 2020

Summary

Introduction

The End Tuberculosis (TB) Strategy has the ambitious goal of ending the global TB epidemic by the year 2030, which is aligned to the Sustainable Development Goals (SDGs) [1]. To measure the progress against this ambitious goal, the Strategy has three main high level indicators These include a reduction in TB incidence rate by 80%, a reduction in number of TB deaths by 90%, and ensuring that no TB-affected household experiences “catastrophic costs” associated with TB diagnosis and care, which are all to be achieved by 2030, relative to baseline estimates in 2015 [1]. Costs in relation to income were higher for patients with lower incomes and for people with multi-drug resistant TB (MDR-TB) [3] Such costs create barriers to health care access and treatment adherence, which in turn can affect treatment outcomes [5] and prolong TB transmission. Our review of the evidence on the costs of TB care is focused on the Western-Pacific Region of WHO (comprising 37 countries and areas)

What are Catastrophic Costs in the Context of the End TB Strategy?

How Does “Catastrophic Costs” Differ from “Catastrophic Health Spending”?

Costs of TB Care in the Western Pacific Region

Findings

Conclusions