393 Costs associated with tuberculosis diagnosis and treatment in Yemen for patients and public health services

Abstract

This study determined the costs associated with tuberculosis (TB) diagnosis and treatment for the public health services and patients in Sana'a, Yemen. Data were collected prospectively from 320 pulmonary and extrapulmonary TB patients (160 each) who were followed until completion of treatment. Direct medical and nonmedical costs and indirect costs were calculated. The proportionate cost to the patients for pulmonary TB and extrapulmonary TB was 76.1% and 89.4% respectively of the total for treatment. The mean cost to patients for pulmonary and extrapulmonary TB treatment was US$ 108.4 and US$ 328.0 respectively. The mean cost per patient to the health services for pulmonary and extrapulmonary TB treatment was US$ 34.0 and US$ 38.8 respectively. For pulmonary and extrapulmonary TB, drug treatment represented 59.3% and 77.9% respectively of the total cost to the health services. The greatest proportionate cost to patients for pulmonary TB treatment was time away from work (67.5% of the total cost), and for extrapulmonary TB was laboratory and X-ray costs (55.5%) followed by transportation (28.6%). Coûts associés au diagnostic et au traitement de la tuberculose pour les patients et les services de santé publics au Yémen RÉSUMÉ La présente étude a déterminé les coûts associés au diagnostic et au traitement de la tuberculose pour les services de santé publics et pour les patients à Sanaa (Yémen). Les données ont été recueillies de façon prospective auprès de 320 patients atteints de tuberculose pulmonaire et extrapulmonaire (160 pour chaque forme), suivis jusqu'à la fin de leur traitement. Les coûts médicaux et non médicaux directs et les coûts indirects ont été calculés. La part du coût supportée par les patients était de 76,1 % du coût total du traitement dans le cas de la tuberculose pulmonaire, et de 89,4 % dans le cas de la tuberculose extrapulmonaire. Le coût moyen du traitement de la tuberculose pulmonaire et extrapulmonaire pour les patients était respectivement de 108,4 USD et 328,0 USD, ce qui équivalait à un coût moyen par patient de 34,0 USD et 38,8 USD, respectivement. Pour les services de santé, le traitement médicamenteux de la tuberculose pulmonaire et extrapulmonaire représentait 59,3 % et 77,9 % respectivement du coût total. Pour les patients atteints de tuberculose pulmonaire, l'absence du travail représentait le coût le plus important du traitement (67,5 % du coût total) ; pour les patients atteints de tuberculose extrapulmonaire, les dépenses liées aux analyses de laboratoire et auxradiographies (55,5 %) étaient les coûts proportionnellement les plus importants, suivies par les frais de transport (28,6 %).

Resource utilization pattern and cost of tuberculosis treatment from the provider and patient perspectives in the state of Penang, Malaysia

“…These results are somewhat comparable to the findings of similar studies published elsewhere [10, 13]. However, a few studies from developing and developed countries showed that the cost of TB medicines ranged from 4.7–63.8% of the total cost of TB management [6, 9–11, 14, 32]. Differences in cost accounting methods, characteristics of study population and variability in the unit cost of TB medicines are some of the factors that could explain inconsistency in the findings of various studies.…”

“…Among these out-of-pocket payments, transportation and special food costs created the highest impact. Consistent with our findings, studies from the Netherlands, Tajikistan, Yemen, India and Thailand reported higher transportation and special food costs [7, 12, 14, 22, 33]. As such, weekly packing of TB drugs in the presence of suitable treatment supporters could be an option to reduce the out-of-pocket costs to the patients.…”

“…The average patient cost was slightly higher (54.3%) than the provider cost. Recently, a study from Western Asia showed that the average cost of treating a PTB patient was USD 142.40, in which patient costs constituted 76.1% of the total cost [14]. In 2005, a Tanzania study reported that on an average USD 145.00 were required to treat an episode of TB, whereby the provider costs constituted 70.3% of the total cost [11].…”

“…Studies from developing countries have demonstrated that an average cost for the treatment of a drug susceptible TB case ranged from USD 94.00 to USD 2058.00 [4, 8–14]. Similarly, studies from developed countries have shown a considerable fluctuation in the average cost of TB treatment [6, 15].…”

Comparison of two cash transfer strategies to prevent catastrophic costs for poor tuberculosis-affected households in low- and middle-income countries: An economic modelling study

“…Data extracted from eligible TB-related cost surveys comprised: survey country, year of data collection, survey setting, survey sample size, local currency unit exchange rate, methods used to estimate TB-related costs, and mean TB-related costs stratified into subcategories of direct, indirect, and total TB-related costs. In Brazil and Yemen, where articles reported mean TB-related costs for different patient subgroups (e.g., directly observed therapy versus self-administered therapy), an unweighted mean overall estimate was calculated across subgroups [ 33 , 34 ].…”