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Journal of Tuberculosis Research 2020年第4期8卷 181-198页

作者： Aamer Ikram Amna Ali Sana Habib Abbasi Nosheen Ashraf Sidra Wali Mohammad Salman Mumtaz A. Khan Naveed Syed Jamil A. Ansari National Institute of Health Islamabad Pakistan Public Health England London UK

Background: The interplay between financial deprivation and tuberculosis (TB) is considered one of the vital socio-economic determinants of disease. This is the first study of its kind to be carried in Pakistan, which aims to identify leading factors contributing towards catastrophic costs of TB diagnosis and management in order to help policy makers. Methodology: From four tertiary care hospitals (TCH) in Islamabad and Rawalpindi, 400 TB patients were interviewed through a cross-sectional survey. The patient’s pre and post-TB income and direct and indirect costs for treatment were analysed following WHO recommendations. Multivariable logistic regression model was used to identify the determinants of catastrophic total cost. Results: For TB management expenditures, the median (interquartile range) of total costs by households was Rs. 58,175 Rs (32,050 - 97,500). At 20% threshold, 67% of TB patient’s households were affected by catastrophic

关键词： Tuberculosis Financial Deprivation catastrophic cost

Is convenience really king?Comparative evaluation of catastrophic costs due to tuberculosis in the public and private healthcare sectors of Viet Nam:a longitudinal patient cost study

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Infectious Diseases of Poverty 2024年第2期13卷 17-28页

作者： Hoa Binh Nguyen Luan Nguyen Quang Vo Rachel Jeanette Forse Anja Maria Christine Wiemers Huy Ba Huynh Thuy Thi Thu Dong Yen Thi Hoang Phan Jacob Creswell Thi Minh Ha Dang Lan Huu Nguyen Jad Shedrawy Knut Lönnroth Tuan Dinh Nguyen Luong Van Dinh Kristi Sidney Annerstedt Andrew James Codlin National Lung Hospital Ha NoiViet Nam Friends for International TB Relief Ha NoiViet Nam Department of Global Public Health WHO Collaboration Centre On Tuberculosis and Social MedicineKarolinska InstituteStockholmSweden Stop TB Partnership GenevaSwitzerland Pham Ngoc Thach Hospital Ho Chi Minh CityViet Nam

Background In Viet Nam,tuberculosis(TB)represents a devastating life-event with an exorbitant price tag,partly due to lost income from daily directly observed therapy in public sector ***,persons with TB may seek care in the private sector for its flexibility,convenience,and *** study aimed to measure income changes,costs and catastrophic cost incurrence among TB-affected households in the public and private *** Between October 2020 and March 2022,we conducted 110 longitudinal patient cost interviews,among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program(NTP)in Ha Noi,Hai Phong and Ho Chi Minh City,Viet *** a local adaptation of the WHO TB patient cost survey tool,participants were interviewed during the intensive phase,continuation phase and *** compared income levels,direct and indirect treatment costs,catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate *** The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort(USD 868 vs USD 578;P=0.010).However,private sector treatment was also significantly costlier(USD 2075 vs USD 1313;P=0.005),driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants(USD 754 vs USD 164;Pcatastrophic costs between the two cohorts(Private:55%vs NTP:52%;P=0.675).Factors associated with catastrophic cost included being a single-person household[adjusted odds ratio[(a OR=13.71;95%confidence interval(CI):1.36-138.14;P=0.026)],unemployment during treatment(a OR=10.86;95%CI:2.64-44.60;Pcatastrophic costs whether treated in the public or private *** costs coul

关键词： Tuberculosis Patient cost catastrophic cost Private sector Comparative analysis Viet Nam

The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

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Infectious Diseases of Poverty 2019年第6期8卷 61-75页

作者： Suman Chandra Gurung Kritika Dixit Bhola Rai Maxine Caws Puskar Raj Paudel Raghu Dhital Shraddha Acharya Gangaram Budhathoki Deepak Malla Jens W.Levy Job van Rest Knut Lonnroth Kerri Viney Andrew Ramsay Tom Wingfield Buddha Basnyat Anil Thapa Bertie Squire Duolao Wang Gokul Mishra Kashim Shah Anil Shrestha Noemia Teixeira de Siqueira-Filha Birat Nepal Medical Trust KathmanduNepal Department of Clinical Sciences Liverpool School of Tropical MedicineLiverpoolUK KNCV Tuberculosis Foundation The HagueNetherlands Department of Public Health Sciences Karolinska InstitutetStockholmSweden Research School of Population Health Australian National UniversityCanberraAustralia University of St Andrews St AndrewsUK University of Liverpool LiverpoolUK Oxford University Clinical Research Unit KathmanduNepal National Tuberculosis Centre BhaktapurNepal Nick Simons Institute LalitpurNepal Institute for Health Technology Assessment Porto AlegreBrazil

Background:The World Health Organization(WHO)End TB Strategy has established a milestone to reduce the number of tuberculosis(TB)-affected households facing catastrophic costs to zero by *** role of active case finding(ACF)in reducing patient costs has not been determined *** study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding(PCF),and to determine the prevalence and intensity of patient-incurred catastrophic costs in ***:The study was conducted in two districts of Nepal:Bardiya and Pyuthan(Province No.5)between June and August *** hundred patients were included in this study in a 1:1 ratio(PCF:ACF,25 consecutive ACF and 25 consecutive PCF patients in each district).The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical *** costs were calculated based on the proportion of patients with total costs exceeding 20%of their annual household *** intensity of catastrophic costs was calculated using the positive overshoot *** chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and ***,the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of ***:Ninety-nine patients were interviewed(50 ACF and 49 PCF).Patients diagnosed through ACF incurred lower costs during the pre-treatment period(direct medical:USD 14 vs USD 32,P=0.001;direct non-medical:USD 3 vs USD 10,P=0.004;indirect,time loss:USD 4 vs USD 13,Pcost of the pre-treatment and intensive phases combined was also lower for direct medical(USD 15 vs USD 34,P=0.002)and non-medical(USD 30 vs USD 54,P=0.022)costs among ACF *** prevalence of catastrophic direct costs was lower for ACF patients for all thresholds.A lower intensity of catastrophic costs was also documented for ACF patients,altho

关键词： Tuberculosis Case finding cost catastrophic cost Patient-incurred cost Nepal

Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia:eight simulated scenarios

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Infectious Diseases of Poverty 2019年第1期8卷 100-100页

作者： Ahmad Fuady Tanja A.J.Houweling Muchtaruddin Mansyur Erlina Burhan Jan Hendrik Richardus Departm ent of Public Health Erasmus MCUniversity Medical Centre RotterdamP.O.Box 20403000CARotterdamthe Netherlands Department of Community Medicine Faculty of MedicineUniversitas IndonesiaJakartaIndonesia 不详

Background:The World Health Organization's End Tuberculosis Strategy states that no tuberculosis(TB)-affected households should endure catastrophic costs due to *** achieve this target,it is essential to provide adequate social *** only a few studies in many countries have evaluated social-protection programs to determine whether the target is being reached,we assessed the effect of financial support on reducing the incidence of catastrophic costs due to TB in ***:From July to Septem ber 2016,we interviewed adult patients receiving treatment for TB in 19 primary health centres in urban,sub-urban and rural area of Indonesia,and those receiving multidrug-resistant(MDR)TB treatment in an Indonesian national referral *** on the needs assessment,we developed eight scenarios for financial *** assessed the effect of each simulated scenario by measuring reductions in the incidence of catastrophic ***:We analysed data of 282 TB and 64 MDR-TB *** incidences of catastrophic costs in affected households were 36 and 83%,***'primary needs for social protection were financial support to cover costs related to income loss,transportation,and food *** optimum scenario,in which financial support would be provided for these three items,would reduce the respective incidences of catastrophic costs in TB and MDR-TB-affected households to 11 and 23%.The patients experiencing catastrophic costs in this scenario would,however,have to pay high rem aining costs(median of USD 910;[interquartile range(IQR)662]in the TB group,and USD 2613;[IQR 3442]in the MDR-TB group).Conclusions:Indonesia's current level of social protection is not sufficient to mitigate the socioeconom ic im pact of *** support for income loss,transportation costs,and food-supplem ent costs will substantially reduce the incidence of catastrophic costs,but financial support alone will not be sufficient to achieve the target of

关键词： Tuberculosis Multidrug-resistant tuberculosis catastrophic cost Social protection Financial support Cash transfer Indonesia

Tuberculosis care strategies and their economic consequences for patients: the missing link to end tuberculosis

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Infectious Diseases of Poverty 2016年第1期5卷 847-856页

作者： Belete Getahun Moges Wubie Getiye Dejenu Tsegahun Manyazewal Debre Markos University P.O.Box 269Debre MarkosEthiopia Ethiopian Public Health Association P.O.Box 7117Addis AbabaEthiopia

Background:While investment in the development of Tuberculosis(TB)treatment strategies is essential,it cannot be assumed that the strategies are affordable for TB patients living in countries with high economic *** study aimed to determine the economic consequences of directly observed therapy for TB ***:A cross-sectional cost-of-illness analysis was conducted between September to November 2015 among 576 randomly selected adult TB patients who were on directly observed treatment in 27 public health facilities in Addis Ababa,*** were collected using interviewer-administered questionnaire adapted from the Tool to Estimate Patients’*** and median costs,reduction of productivity,and household expenditure of TB patients were calculated and ways of coping costs ***(η),Odds ratio and p values were used to measure association between ***:Of the total 576 TB patients enrolled,43%were smear-positive pulmonary TB(PTB),17%smear-negative PTB,37%Extra-PTB and 3%multi-drug resistant TB ***(Out-of-Pocket)mean and median costs of TB illness to patients were$123.0(SD=58.8)and$125.78(R=338.12),respectively,and indirect(loss income)mean and median costs were$54.26(SD=43.5)and$44.61(R=215.6),*** and median total cost of TB illness to patient were$177.3(SD=78.7)and$177.1(R=461.8),*** total cost had significant association with patient’s household income,residence,need for additional food,and primary income(Pcosts were catastrophic for 63%of TB patients,regardless of significant difference between gender(P=0.92)and type of TB cases(P=0.37).TB patients mean productivity and income reduced by 37 and 10%,respectively,compared with pre-treatment level,while mean household expenditure increased by 33%and working hours reduced by 78%due to TB *** quartile categories were directly correlated with catastrophic costs(η=0.684).Conclusion:Despite the availability of free-of-

关键词： Tuberculosis Directly observed therapy(DOT) cost of TB Out-of-pocket(OOP)payments Loss income catastrophic cost End TB High-burden countries Ethiopia

costs incurred by patients with drugsusceptible pulmonary tuberculosis in semiurban and rural settings of Western India

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Infectious Diseases of Poverty 2020年第5期9卷 125-125页

作者： Mihir P.Rupani Adithya Cattamanchi Priya B.Shete William M.Vollmer Sanjib Basu Jigna D.Dave Department of Community Medicine Government Medical College Bhavnagar(Maharaja Krishnakumarsinhji Bhavnagar University)Near ST Bus StandJail RoadBhavnagarGujarat 364001India 不详

Background:India reports the highest number of tuberculosis(TB)cases *** has a dual impact as it increases the risk of TB and exposes the poor to economic hardship when they develop *** objective was to estimate the costs incurred by patients with drug-susceptible TB in Bhavnagar(western India)using an adapted World Health Organization costing ***:We conducted a descriptive cross-sectional study of adults,notified in the public sector and being treated for drug-susceptible pulmonary TB during January-June 2019,in six urban and three rural blocks of Bhavnagar region,Gujarat state,*** direct and indirect TB-related costs,as well as patients’coping strategies,were assessed for the overall care of TB till treatment *** costs were defined as total costs>20%of annual household income(excluding any amount received from cash transfer programs or borrowed).Median and interquartile range(IQR)was used to summarize patient *** median costs between any two groups were compared using the median *** association between any two categorical variables was tested by the Pearson chi-squared *** costs were described in US dollars(USD).During the study period,on average,one USD equalled 70 Indian ***:Of 458 patients included,70%were male,62%had no formal education,71%lived in urban areas,and 96%completed TB *** median(IQR)total costs were USD 8(5-28),direct medical costs were USD 0(0-0),direct non-medical costs were USD 3(2-4)and indirect costs were USD 6(3-13).Among direct non-medical costs,travel cost(median=USD 3,IQR:2-4)to attend health facilities were the most prominent,whereas the indirect costs were mainly contributed by the patient’s loss of wages(median=USD 3,IQR:0-6).Four percent of patients faced catastrophic costs,11%borrowed money to cover costs and 7%lost their employment;the median working days lost to TB was 30(IQR:15-45).A majority(88%)of patients received a median USD 43(IQR:41-43)a

关键词： Tuberculosis cost tool catastrophic cost Healthcare cost Treatment outcome National tuberculosis program India Coping Cash transfer National tuberculosis elimination program American thoracic society-methods in epidemiologic clinical and operations research