Identifying costs contributing to catastrophic expenditure among TB patients registered under RNTCP in Delhi metro city in India

Sarin, Rohit; Vohra, Vikram; Singla, Neeta; Thomas, Beena; Rajendran, K.; Muniyandi, Malaisamy

doi:10.1016/j.ijtb.2018.10.009

Cited by 24 publications

(24 citation statements)

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“…The median costs reported in the present study were lower than those reported in most other studies from India [9,10,12,13,16,17,22,23]. The discrepancy might be because the current study estimated the costs among drug-susceptible pulmonary TB patients, whereas the published literature is inclusive of cost estimates on drug-resistant and extra-pulmonary TB patients.…”

Section: Discussioncontrasting

confidence: 85%

“…Evidence suggests that the self-reported annual household incomes are lower than estimates based on assets, consumption, or expenditure [24]. However, most studies in other countries also used self-reported income and the percentage of households facing catastrophic costs found in the present study were comparable to a recent study conducted in New Delhi [9]. In contrast to the present study, a study in Peru found a significant association between catastrophic costs and adverse treatment outcomes among tuberculosis patients [8].…”

Section: Discussioncontrasting

confidence: 69%

“…In response to call for additional socioeconomic support for TB patients, the National TB Program (NTP) in India rolled out a direct benefit transfer (DBT) scheme in April 2018 with a credit of USD 7 (Indian Rupees [INR] 500) every month to support the nutritional requirements of TB patients [18]. However, only a few studies have assessed the complete costs incurred through treatment completion by TB patients in India using a validated WHO tool [9,11,12].…”

Section: Introductionmentioning

confidence: 99%

“…Studies in India reported the percentage of catastrophic costs among drug-susceptible TB patients to be between 7 and 32% [ 9 – 12 ]. The average costs incurred by drug-susceptible TB patients treated in government health facilities are approximately USD 179, [ 9 , 10 ] whereas costs incurred by TB patients accessing care in all types of health facilities range from USD 20 to 224 [ 13 – 17 ]. In response to call for additional socioeconomic support for TB patients, the National TB Program (NTP) in India rolled out a direct benefit transfer (DBT) scheme in April 2018 with a credit of USD 7 (Indian Rupees [INR] 500) every month to support the nutritional requirements of TB patients [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Costs incurred by patients with drug-susceptible pulmonary tuberculosis in semi-urban and rural settings of Western India

et al. 2020

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Background India reports the highest number of tuberculosis (TB) cases worldwide. Poverty has a dual impact as it increases the risk of TB and exposes the poor to economic hardship when they develop TB. Our objective was to estimate the costs incurred by patients with drug-susceptible TB in Bhavnagar (western India) using an adapted World Health Organization costing tool. Methods We conducted a descriptive cross-sectional study of adults, notified in the public sector and being treated for drug-susceptible pulmonary TB during January–June 2019, in six urban and three rural blocks of Bhavnagar region, Gujarat state, India. The direct and indirect TB-related costs, as well as patients’ coping strategies, were assessed for the overall care of TB till treatment completion. Catastrophic costs were defined as total costs > 20% of annual household income (excluding any amount received from cash transfer programs or borrowed). Median and interquartile range (IQR) was used to summarize patient costs. The median costs between any two groups were compared using the median test. The association between any two categorical variables was tested by the Pearson chi-squared test. All costs were described in US dollars (USD). During the study period, on average, one USD equalled 70 Indian Rupees. Results Of 458 patients included, 70% were male, 62% had no formal education, 71% lived in urban areas, and 96% completed TB treatment. The median (IQR) total costs were USD 8 (5–28), direct medical costs were USD 0 (0–0), direct non-medical costs were USD 3 (2–4) and indirect costs were USD 6 (3–13). Among direct non-medical costs, travel cost (median = USD 3, IQR: 2–4) to attend health facilities were the most prominent, whereas the indirect costs were mainly contributed by the patient’s loss of wages (median = USD 3, IQR: 0–6). Four percent of patients faced catastrophic costs, 11% borrowed money to cover costs and 7% lost their employment; the median working days lost to TB was 30 (IQR: 15–45). A majority (88%) of patients received a median USD 43 (IQR: 41–43) as part of a cash transfer program for TB patients. Conclusions Treatment completion was high and the costs incurred by TB patients were low in this setting. However, negative financial consequences occur even in low-cost settings. The role of universal cash transfer programs in such settings requires further study.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussioncontrasting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Costs incurred by patients with drug-susceptible pulmonary tuberculosis in semi-urban and rural settings of Western India

et al. 2020

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“…The pooled proportion of the direct cost to the total cost addressed in 14 studies, the pooled proportion of direct to total cost was 55%, 95%CI [43-66%], I 2 = 99%. After conducting outliers removal, the studies [16,43,44,[48][49][50] were excluded, the pooled proportion dropped to 51%, 95%CI [43-59%], I 2 = 96%. In this study, we have found that there are six studies that also calculated the CHE 10% and the CTP 40%, in addition to their results regarding the CTC 20%.…”

Section: Proportion Of Direct Cost To Total Cost In Case Hiv and Tbmentioning

confidence: 99%

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

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et al. 2021

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Background: As one of the World Health Organization (WHO) End Tuberculosis (TB) Strategy is to reduce the proportion of TB affected families that face catastrophic costs to 0% by 2020. This systematic review and meta-analysis aimed to estimate the pooled proportion of TB affected households who face catastrophic cost. Method: A search of the online database through September 2020 was performed. A total of 5114 articles were found, of which 29 articles got included in quantitative synthesis. Catastrophic cost is defined if total cost related to TB exceeded 20% of annual pre-TB household income. R software was used to estimate the pooled proportion at 95% confidence intervals (CIs) using the fixed/random-effect models. Result: The proportion of patients faced catastrophic cost was 43% (95% CI 34-52, I2= 99%. 32% (95% CI 29 - 35, I2= 70%) among drug sensitive, and 80% (95% CI 74-85, I2=54%) among drug resistant, and 81% (95% CI 78-84%, I2= 0%) among HIV patients. Regarding active versus passive case finding the pooled proportion of catastrophic cost was 12% (95% CI 9-16, I2= 95%) versus 42% (95% CI 35-50, I2= 94%). The pooled proportion of direct cost to the total cost was 45% (95% CI 39-51, I2= 91%). The pooled proportion of patients facing catastrophic health expenditure (CHE) at cut of point of 10% of their yearly income was 45% (95% CI 35-56, I2= 93%) while at 40% of their capacity to pay was 63% (95% CI 40-80, I2= 96%). Conclusion: Despite the ongoing efforts, there is a significant proportion of patients facing catastrophic cost, which represent a main obstacle against TB control.

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Association of Tuberculosis With Household Catastrophic Expenditure in South India

et al. 2020

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IMPORTANCE The high household costs associated with tuberculosis (TB) diagnosis and treatment can create barriers to access and adherence, highlighting the urgency of achieving the World Health Organization's End TB Strategy target that no TB-affected households should face catastrophic costs by 2020.OBJECTIVE To estimate the occurrence of catastrophic costs associated with TB diagnosis and treatment and to identify socioeconomic indicators associated with catastrophic costs in a setting where TB control strategies have been implemented effectively. DESIGN, SETTING, AND PARTICIPANTSIn this cross-sectional study, 455 patients with TB in the Chennai metropolitan area of South India who were treated under the TB control program between February 2017 and March 2018 were interviewed. Patients were interviewed by trained field investigators at 3 time points: at the initiation of treatment, at the end of the intensive phase of treatment, and at the end of the continuation phase of treatment. A precoded interview schedule was used to collect information on demographic, socioeconomic, and clinical characteristics and direct medical, direct nonmedical, and indirect costs. Data analysis was performed from August 2018 to November 2019. MAIN OUTCOMES AND MEASURES Direct, indirect, and total costs to patients with TB.Catastrophic costs associated with TB were defined as costs exceeding 20% of the household's annual income. A binary response model was used to determine the factors that were significantly associated with catastrophic costs. RESULTSOf 455 patients with TB interviewed, 205 (53%) were aged 19 to 45 years (mean [SD] age, 38.4 [16.0] years), 128 (33%) were female, 72 (19%) were illiterate, 126 (33%) were employed, and 186 (48%) had a single earning member in the family (percentages are based on the 384 patients who were interviewed through the end of the continuation phase of treatment). Sixty-one percent of patients (234 patients) had pulmonary smear positive TB. The proportion of patients with catastrophic costs was 31%. Indirect costs contributed more toward catastrophic cost than did direct costs. Multivariate logistic regression analysis found that unemployment (adjusted odds ratio, 0.2; 95% CI, 0.1-0.5; P < .001) and higher annual household income (Rs 1-200 000, adjusted odds ratio, 0.4; 95% CI, 0.2-0.7; P = .004; Rs >200 000, adjusted odds ratio, 0.2; 95% CI, 0.1-0.5; P < .001) were associated with a decreased likelihood of experiencing catastrophic costs. CONCLUSIONS AND RELEVANCEDespite the implementation of free diagnostic and treatment services under a national TB control program, TB-affected households had a high risk of catastrophic (continued) Key Points Question What are the costs incurred by patients with tuberculosis (TB) throughout the treatment period in a resource-poor country such as India, where diagnostic testing and TB treatment are provided free of charge? Findings In this cross-sectional study of 455 individuals with TB, despite the implementation of free diagnostic and treatment services un...

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Identifying costs contributing to catastrophic expenditure among TB patients registered under RNTCP in Delhi metro city in India

Cited by 24 publications

References 13 publications

Costs incurred by patients with drug-susceptible pulmonary tuberculosis in semi-urban and rural settings of Western India

Costs incurred by patients with drug-susceptible pulmonary tuberculosis in semi-urban and rural settings of Western India

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

Association of Tuberculosis With Household Catastrophic Expenditure in South India

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