Journey of the tuberculosis patients in India from onset of symptom till one-year post-treatment

Abstract

Historically, economic studies on tuberculosis estimated out-of-pocket expenses related to tuberculosis treatment and catastrophic cost, however, no study has yet been conducted to understand the post-treatment economic conditions of the tuberculosis patients in India. In this paper, we add to this body of knowledge by examining the experiences of the tuberculosis patients from the onset of symptoms till one-year post-treatment. 829 adult drug-susceptible tuberculosis patients from general population and from two high risk groups: urban slum dwellers and tea garden families were interviewed during February 2019 to February 2021 at their intensive and continuation phases of treatment and about one-year post-treatment using adapted World Health Organization tuberculosis patient cost survey instrument. Interviews covered socio-economic conditions, employment status, income, out-of-pocket expenses and time spent for outpatient visits, hospitalization, drug-pick up, medical follow-ups, additional food, coping strategies, treatment outcome, identification of post-treatment symptoms and treatment for post-treatment sequalae/recurrent cases. All costs were calculated in 2020 Indian rupee (INR) and converted into US dollar (US$) (1 US$ = INR 74.132). Total cost of tuberculosis treatment since the onset of symptom till one-year post-treatment ranged from US$359 (Standard Deviation (SD) 744) to US$413 (SD 500) of which 32%-44% of costs incurred in pre-treatment phase and 7% in post-treatment phase. 29%-43% study participants reported having outstanding loan with average amount ranged from US$103 to US$261 during the post-treatment period. 20%-28% participants borrowed during post-treatment period and 7%-16% sold/mortgaged personal belongings. Therefore, economic impact of tuberculosis persists way beyond treatment completion. Major reasons of continued hardship were costs associated with initial tuberculosis treatment, unemployment, and reduced income. Therefore, policy priorities to reduce treatment cost and to protect patients from the economic consequences of the disease by ensuring job security, additional food support, better management of direct benefit transfer and improving coverage through medical insurances need consideration.

Tuberculosis patients face high treatment support costs in Colombia, 2021

“…Assuming that patients finish treatment is a limitation as it doesn’t account for patients who may not finish treatment because of system related loss to follow-up (14). A longitudinal study design, as has been recently done in India [ 43 ] provides an alternative that can provide insight onto these important aspects of patient care and wellbeing, but such survey has larger time and financial investments requirements.…”

Catastrophic costs for tuberculosis patients in India: Impact of methodological choices

“…Further, Assam (northeast India), Tamil Nadu (south), and West Bengal (east) are the states where most tea gardens are located, while Maharashtra (west), Tamil Nadu and West Bengal are among the top five states in terms of urban slum population in the country. Methods of state selection, details of 'high-risk groups', and sample size calculation for the study are presented elsewhere [11].…”

“…Catastrophic cost was defined as total TB treatment cost (direct + indirect cost) �20% pre-TB annual household income [2]. Earlier Indian studies used annual pre-TB household income as denominator of catastrophic cost calculation [6][7][8][9][10][11]. However, household expenditure is a better measure of permanent income of the household as it generally stays stable over time [14,15].…”

“…Patients pay 'outof-pocket' for several other components such as consultation fees, non-TB drugs, other diagnostic tests (for example, computed tomography scan, magnetic resonance imagining, biopsy), travel expenses in pre-treatment period (i.e., from symptom onset to treatment initiation) and travel expenses for picking up TB drugs, additional food / nutritional supplements, management of side effects during treatment period. Studies showed high cost associated with TB treatment in India and 7%-40% drug-susceptible (DS) TB patients reported facing catastrophe using the threshold of �20% of pre-TB household annual income [6][7][8][9][10][11]. However, majority of those were small scale cross-sectional studies the results of which will be difficult to generalize for Indian context.…”

A Descriptive Analytical Study to Assess the Knowledge and Practice of Proper Face Mask Wearing among Healthcare Professionals, Patients and Attendants in a Tertiary Care Center of North India

“…A recent study conducted in the year 2023 estimates ₹26,500-30,500 per patient total cost of TB treatment from the onset of symptoms until 1-year posttreatment. 6 Therefore, proper face mask wearing becomes a cost-effective preventative measure against TB infection, especially in crowded places such as hospitals often have poor cross-ventilation. The latter can further increase the chances of cross-infection to healthy persons and HCWs from TB patients.…”