Patient-cost survey for tuberculosis in the context of patient-pathway modelling

Abstract

SETTING: Eight tuberculosis treatment sites in Cavite Province, the Philippines, including two sites specialising in management of multidrug-resistant tuberculosis (MDR-TB).OBJECTIVE: To evaluate costs incurred by TB patients and to determine the proportion of households that faced catastrophic costs, then to consider cost survey responses alongside results of detailed patient-pathway modelling.DESIGN: Clustered cross-sectional survey using a field testing version of the WHO TB patient-costing tool and protocol; face-to-face interviews with 194 patients conducted in May–August 2016. Costs included direct-medical, direct non-medical and indirect costs using the human capital approach. Patients were deemed to incur catastrophic expenditure if TB-related costs exceeded 20% of annual household income. Patient pathways were modelled following multiple health staff interviews.RESULTS: Estimated mean cost incurred by patients with drug-susceptible TB was US$321 vs. $2356 for MDR-TB patients. Catastrophic costs were suffered by 28% of drug-susceptible and 80% of MDR-TB patients, with lost income being the largest contributor. Patient-pathway modelling suggested most patients had under-reported health visits.CONCLUSION: Survey results indicate that patient costs are large for all patients in Cavite, particularly for MDR-TB patients. Patient-pathway modelling suggests these costs are an underestimate due to poor recollection of health visits, suggesting that the WHO instrument and protocol could be improved to better capture the diagnostic journey.

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

“…2018 [41], Tomeny, 2020 [15], and Collins Timire, 2020 [47] with proportion of 32%, 34% and 49% respectively, while high proportion also reported in Muttamba, 2020 [30], with 66% and in Nhung, 2018 [37] with 68%. The pooled proportion of direct to total cost was difficult to assess because of the heterogeneity which wasn't explained even after a meta-regression performed.…”

“…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.…”

“…Many studies used this cost survey to report catastrophic cost, catastrophic health expenditure, or hardship financing incurred by TB patients [12][13][14]. Some literatures calculated catastrophic cost for drug sensitive, MDR or HIV co-infection [14][15][16]. Other studies estimated compared this cost considering adoption of different case finding strategies (ACF versus PCF) [17,18].…”

A Systematic Review and Meta-Analysis on Catastrophic Cost Incurred by Tuberculosis Patients

“…[29], to 1178 [30]. The tool used for estimation of the cost survey were either WHO TB cost survey tool, [5], [15], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40] & [44], or adapted WHO tool to Indonesian context [12] & [41], or structured questionnaire [17], [26], [42], [43], pre-coded interview scheduled [18],or tool of stop TB partnership, [13], [27], [28],or headcount tool [44], or Lumley T. survey [14], or TB coalition tool [16]. On the other hand, there were two studies not mentioned the tool used [29], [45].…”

“…Many studies used this cost survey to report catastrophic cost, catastrophic health expenditure, or hardship nancing incurred by TB patients [12][13][14]. Some literatures calculated catastrophic cost for drug sensitive, MDR or HIV co-infection [14][15][16]. Other studies estimated compared this cost considering adoption of different case nding strategies (ACF versus PCF) [17,18].…”