Factors that determine catastrophic expenditure for tuberculosis care: a patient survey in China

Abstract

BackgroundTuberculosis (TB) often causes catastrophic economic effects on both the individual suffering the disease and their households. A number of studies have analyzed patient and household expenditure on TB care, but there does not appear to be any that have assessed the incidence, intensity and determinants of catastrophic health expenditure (CHE) relating to TB care in China. That will be the objective of this paper.MethodsThe data used for this study were derived from the baseline survey of the China Government – Gates Foundation TB Phase II program. Our analysis included 747 TB cases. Catastrophic health expenditure for TB care was estimated using two approaches, with households defined as experiencing CHE if their annual expenditure on TB care: (a) exceeded 10 % of total household income; and (b) exceeded 40 % of their non-food expenditure (capacity to pay). Chi-square tests were used to identify associated factors and logistic regression analysis to identify the determinants of CHE.ResultsThe incidence of CHE was 66.8 % using the household income measure and 54.7 % using non-food expenditure (capacity to pay). An inverse association was observed between CHE rates and household income level. Significant determinants of CHE were: age, household size, employment status, health insurance status, patient income as a percentage of total household income, hospitalization and status as a minimum living security household. Factors including gender, marital status and type of TB case had no significant associations with CHE.ConclusionsCatastrophic health expenditure incidence from TB care is high in China. An integrated policy expanding the free treatment package and ensuring universal coverage, especially the height of UHC for TB patients, is needed. Financial and social protection interventions are essential for identified at-risk groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0100-6) contains supplementary material, which is available to authorized users.

Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India

“…HIV coinfection and hospitalization were significantly associated with catastrophic TB costs as reported previously [12,16,23]. Hospitalization increases cost due to direct and indirect patient, and guardian costs involved.…”

“…Zhou et al . have reported a total median direct cost of US$637 in rural China despite free TB care being offered [12]. The total median direct cost was estimated at US$41.1 among a tribal population in India by Muniyandi et al .…”

“…Incidence of catastrophic costs in China was 66.8% using the 10% of household income measure [12]. Using 40% of nonfood expenditure, it was 54.7% in China and 44% in Nigeria households [12,16].…”

“…Using 40% of nonfood expenditure, it was 54.7% in China and 44% in Nigeria households [12,16]. Both these studies estimated direct costs only without accounting for the indirect costs.…”

Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

“…Similarly, we identified many studies in the recent period that determined catastrophic costs due to TB care (diagnosis and treatment), but did not provide data specifically for diagnosis [11,33–36]. A systematic review from Africa (studies from 1990 to 2010) revealed that the pre-diagnostic costs for TB varied between 10.4 and 35% of pre-TB AHI [12].…”