Factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in China

Abstract

Background: Certain districts and counties in China designated local general hospital as the designated hospital for tuberculosis (TB) management after the promulgation of the Law of Practicing Physicians in 2009. To our knowledge, there is limited research on catastrophic payments of TB patients under this service model, often with inconsistent conclusions. In addition, there has been no published studies from China using the updated 2018 World Health Organization (WHO) definition of catastrophic total costs due to TB. This study used the latest criterion recommended by the WHO to analyze the incidence of catastrophic total costs for households affected by TB under the designated hospital model and explore its influencing factors. Methods: A cross-sectional analysis was carried out in all ten designated hospitals in Ningbo, China. Eligible pulmonary TB cases confirmed by sputum culture of Mycobacterium tuberculosis were recruited and surveyed from September 2018 to October 2018. We evaluated catastrophic total costs using total costs for TB treatment exceeding 20% of the household's annual pre-TB income. A sensitivity analysis was performed while varying the thresholds. The least absolute shrinkage and selection operator (LASSO) regression were applied to select variables, and multiple logistic regression analysis were used to identify the determinants of catastrophic total costs. Results: A total of 672 patients were included, with a median age of 41 years old. The rate of catastrophic total costs of surveyed households was 37.1%, and that of households affected by MDR was 69.6%. Medical cost accounted for more than 60% of the total cost. 57.7% cases were hospitalized. The hospitalization rates of patients with no comorbidities, no severe adverse drug reactions, and rifampin-sensitive TB were 53.9, 54.9, and 55.3%, respectively. Patients in the poorest households had the highest hospitalization rates (Q1:54.

Prevalence of comorbidities and their associated factors in patients with type 2 diabetes at a tertiary care department in Ningbo, China: a cross-sectional study

“…6 Although HIV infection, tuberculosis and mental health conditions are common comorbidities in patients with T2DM, [31][32][33][34] these were not the most common comorbidities in this study. The prevalences of these infectious diseases are low in Ningbo, [35][36][37][38] and there are chances that mental health conditions were under-reported. It should also be noted that infectious diseases and mental health conditions as index conditions are treated in other specialised hospitals in Ningbo.…”

COVID-19 and Tuberculosis-Related Catastrophic Costs

“…25 In addition to the national costs surveys, many studies reported the incidence of catastrophic costs at the local level, such as district, province, or several provinces. 13,[26][27][28] Despite the various methods applied, the studies at the local level also suggest that the incidence of TB-related catastrophic costs remains high.…”

A Systematic Review and Meta-Analysis on Catastrophic Cost incurred by Tuberculosis Patients and their Households

“…The proportion of the direct cost to the total cost at 20% addressed in 7 studies, ranged from 26% in Chittamany, 2020 [33] to 93% in Yang, 2020 [32]. Low proportions were observed in Fuady,…”

“…With 63% pooled proportion, 95%CI [40-80%], I 2 = 96%, three studies measured the CTP at 40% [12,29,30] and after the sensitivity test the heterogeneity was I 2= 0, while the pooled proportion increased to 70%, 95%CI [64-76%]. Among drug sensitive and drug resistant TB, the proportion of direct cost to the total cost ranged from (33% to 65%) [15,30,33,37,41,47] and (26%-93%) [15,30,32,33,37,41,47] respectively.…”

“…Also travel and transportation affect the direct non-medical costs increasing the suffer of TB patients [30]. Age also considered to affect the prevalence of catastrophic cost whether the young age [27] or the old age [32].…”