A sequential explanatory mixed-methods study on costs incurred by patients with tuberculosis comorbid with diabetes in Bhavnagar, western India

Abstract

Diabetes is one of the commonest morbidity among patients with tuberculosis (TB). We conducted this study to estimate the costs incurred by patients with TB comorbid with diabetes and to explore the perspectives of program managers as well as patients on the reasons and solutions for the costs incurred due to TB-diabetes. We conducted a descriptive cross-sectional study to estimate costs among 304 patients with TB-diabetes comorbidity registered in the public health system during 2017–2020 in the Bhavnagar region of western India, which was followed by in-depth interviews among program functionaries and patients to explore solutions for reducing the costs. Costs, when exceeded 20% of annual household income, were defined as catastrophic as this cut-off was most significantly related to adverse TB outcomes. Among the 304 patients with TB-diabetes comorbidity, 72% were male and the median (interquartile IQR) monthly family income was Indian rupees (INR) 9000 (8000–11,000) [~ US$ 132 (118–162)]. The median (IQR) total costs due to combined TB-diabetes were INR 1314 (788–3170) [~ US$ 19 (12–47)], while that due to TB were INR 618 (378–1933) [~ US$ 9 (6–28)]. Catastrophic costs due to TB were 4%, which increased to 5% on adding the costs due to diabetes. Health system strengthening, an increase in cash assistance, and other benefits such as a nutritious food kit were suggested for reducing the costs incurred. We conclude that, in addition to a marginal increase in the percentage of catastrophic costs, co-existent diabetes nearly doubled the median total costs incurred among patients with TB. Strengthening the TB-diabetes bi-directional activities, tailoring the cash transfer scheme for comorbid patients, and making the common two-drug combination diabetes tablets available at government drug stores would help TB-diabetes comorbid patients cope with the costs of care.

Diabetes and tuberculosis syndemic in India: A narrative review of facts, gaps in care and challenges

“…The median (IQR) total costs due to combined TB‐diabetes were INR 1314 (788–3170 [~US$ 19 (12–47)]), whereas those due to TB were INR 618 (378–1933 [~US$ 9 (6–28)]). The authors concluded that in addition to a marginal increase in the percentage of catastrophic costs, coexistent diabetes nearly doubled the median total costs incurred among patients with TB 46 …”

“…The authors concluded that in addition to a marginal increase in the percentage of catastrophic costs, coexistent diabetes nearly doubled the median total costs incurred among patients with TB. 46 …”

“…Since the WHO initiated an innovative program of “Directly observed treatment, short course” or DOTS in the late 1990s, 46 there has been a steady increase in the use of this program for TB control services. Since 1995, it is estimated that around 41 million cases have been successfully treated and up to 6 million lives were saved through DOTS.…”

The effect of diabetes mellitus on tuberculosis in eastern China: A decision‐tree analysis based on a real‐world study

“…11 In addition, DM may also double the median cost of treatment of patients with TB. 12,13 The presence of comorbidities with TB and DM poses a serious threat to TB control.…”

“…It may even aggravate glucose metabolism disorders and increase the incidence of ketoacidosis 11 . In addition, DM may also double the median cost of treatment of patients with TB 12,13 . The presence of comorbidities with TB and DM poses a serious threat to TB control.…”