Household costs of illness during different phases of tuberculosis treatment in Central Asia: a patient survey in Tajikistan

Abstract

BackgroundIllness-related costs incurred by patients constitute a severe economic burden for households especially in low-income countries. High household costs of illness lead to impoverishment; they impair affordability and equitable access to health care and consequently hamper tuberculosis (TB) control. So far, no study has investigated patient costs of TB in the former Soviet Union.MethodsAll adult new pulmonary TB cases enrolled into the DOTS program in 12 study districts during the study period were enrolled. Medical and non-medical expenditure as well as loss of income were quantified in two interviews covering separate time periods. Costs of different items were summed up to calculate total costs. For missing values, multiple imputation was applied.ResultsA cohort of 204 patients under DOTS, 114 men and 90 women, participated in the questionnaire survey. Total illness costs of a TB episode averaged $1053 (c. $4900 purchasing power parity, PPP), of which $292, $338 and $422 were encountered before the start of treatment, during intensive phase and in continuation phase, respectively. Costs per month were highest before the start of treatment ($145) and during intensive phase ($153) and lower during continuation phase ($95). These differences were highly significant (paired t-test, p < 0.0005 for both comparisons).ConclusionsThe illness-related costs of an episode of TB exceed the per capita GDP of $1600 PPP about two-and-a-half times. Hence, these costs are catastrophic for concerned households and suggest a high risk for impoverishment. Costs are not equally spread over time, but peak in early stages of treatment, exacerbating the problem of affordability. Mitigation strategies are needed in order to control TB in Tajikistan and may include social support to the patients as well as changes in the management of TB cases. These mitigation strategies should be timed early in treatment when the cost burden is highest.

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

“…In contrast, a Haitian study reported 75 DOT visits per patient [32]. Along the same lines, studies from Tanzania and Tajikistan mentioned fewer than 80 DOT visits per patient [11, 12]. Nonetheless, these differences in DOT visits might be associated with difference in treatment strategies (i.e., daily dose vs. twice-weekly dose, DOT at clinic vs. weekly packing of the daily dose) employed at these settings.…”

Out-of-pocket expenditures for primary health care in Tajikistan: a time-trend analysis

“…), characteristics of the household’s dwelling, water, sanitation and consumption of meat. While the 2005, 2007 and 2008 surveys collected the same asset variables, asset indicators were added to the 2011 survey based on the recent work of Ayé [12], allowing to account for change in households wealth related to economic growth (e.g. ownership of mobile phone).…”

“…Furthermore, conducting interviews with tuberculosis (TB) patients in Tajikistan, Ayé et al collected information on medical and non-medical expenditures, as well as loss of income. Their study showed that the three largest shares of the direct costs of TB patients were special foods (29%), drugs (27%) and transport (25%), while medical fees expenditures represented only 7.3% of the direct costs [6]. The expenditures on drugs – legally free of charge for TB patients – concerned mainly additional, symptomatic treatment such as vitamin injections or intravenous rehydration, which are not essential drugs for TB treatment.…”

Hearing loss with kanamycin treatment for multidrug-resistant tuberculosis in Bangladesh

“…Aminoglycosides can produce significant side-effects, including irreversible ototoxicity, estimated to occur in 25–60% of patients treated for MDR-TB, depending on methods of measurement [2–5]. Even if surviving to cure, MDR-TB treatment itself is impoverishing [6], while ototoxicity further limits a patient’s ability to regain employment and may compound social isolation.…”