Abstract
BackgroundOne of the main goals of the post-2015 global tuberculosis (TB) strategy is that no families affected by TB face catastrophic costs. We revised an existing TB patient cost measurement tool to specifically also measure multi-drug resistant (MDR) TB patients’ costs and applied it in Ethiopia, Indonesia and Kazakhstan.MethodsThrough structured interviews with TB and MDR-TB patients in different stages of treatment, we collected data on the direct (out of pocket) and indirect (loss of income) costs of patients and their families related to the diagnosis and treatment of TB and MDR-TB. Direct costs included costs for hospitalization, follow-up tests, transport costs for health care visits, and food supplements. Calculation of indirect costs was based on time needed for diagnosis and treatment. Costs were extrapolated over the patient’s total treatment phase.ResultsIn total 406 MDR-TB patients and 197 other TB patients were included in the survey: 169 MDR-TB patients and 25 other TB patients in Ethiopia; 143 MDR-TB patients and 118 TB patients in Indonesia; and 94 MDR-TB patients and 54 other TB patients in Kazakhstan. Total costs for diagnosis and current treatment episode for TB patients were estimated to be USD 260 in Ethiopia, USD 169 in Indonesia, and USD 929 in Kazakhstan, compared to USD 1838, USD 2342, and USD 3125 for MDR-TB patients, respectively. These costs represented 0.82–4.6 months of pre-treatment household income for TB patients and 9.3–24.9 months for MDR-TB patients. Importantly, 38–92 % reported income loss and 26–76 % of TB patients lost their jobs due to (MDR) TB illness, further aggravating the financial burden.ConclusionsThe financial burden of MDR-TB is alarming, although all TB patients experienced substantial socioeconomic impact of the disease. If the patient is the breadwinner of the family, the combination of lost income and extra costs is generally catastrophic. Therefore, it should be a priority of the government to relieve the financial burden based on the cost mitigation options identified.
Highlights
One of the main goals of the post-2015 global tuberculosis (TB) strategy is that no families affected by TB face catastrophic costs
In Ethiopia, the time period allocated for data collection turned out to be too short and it was decided to focus on reaching the targets for the number of multi-drug resistant (MDR)-TB patients
The median (IQR) number of visits needed for a TB diagnosis was three (2–5) in Ethiopia, three (2–4) in Indonesia, and two (2–3) in Kazakhstan
Summary
One of the main goals of the post-2015 global tuberculosis (TB) strategy is that no families affected by TB face catastrophic costs. Drugs for TB treatment are free in most high TB-burden countries, TB patients face costs due to charges for related health services, costs for transport, accommodation, nutrition and suffer lost income. A recent systematic review showed that the financial burden of both diagnosis and treatment was high and varied widely across settings, the total costs amounting to 58 % (range 5–306 %) of annual patient income [2]. These costs are expected to be higher for patients with multidrug resistant (MDR) TB than for other TB patients given the three to four times’ longer treatment period. This may result in higher health system costs, and is likely to result in continued transmission [6]
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