Tuberculosis treatment is expensive for patients in developing countries

Bevan, Elizabeth A.

doi:10.1136/bmj.315.7101.187a

Cited by 8 publications

(6 citation statements)

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“…This finding is consistent with the studies in other developing countries (Bevan, 1997;Rajeswari et al, 1999;Kamolratanakul et al, 1999). Drug expenditures made up a large proportion of total patient expenditures at the TB station.…”

Section: Discussionsupporting

confidence: 93%

Provision and financial burden of TB services in a financially decentralized system: a case study from Shandong, China

Meng

Cheng

et al. 2004

Int. J. Health Plann. Mgmt.

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Both challenges and opportunities have been created by health sector reforms for TB control programmes in developing countries. China has initiated radical economic and health reforms since the late 1970s and is among the highest TB endemic countries in the world. This paper examines the operation of TB control programmes in a decentralized financial system. A case study was conducted in four counties of Shandong Province and data were collected from document reviews, and key informant and TB patient interviews. The main findings include: direct government support to TB control weakened in poorer counties after its decentralization to township and county governments; DOTS programmes in poorer counties was not implemented as well as in more affluent ones; and TB patients, especially the low-income patients, suffered heavy financial burdens. Financial decentralization negatively affects the public health programmes and may have contributed to the more rapid increase in the number of TB cases seen over the past decade in the poorer areas of China compared with the richer ones. Establishing a financial transfer system at central and provincial levels, correcting financial incentives for health providers, and initiating pro-poor projects for the TB patients, are recommended.

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Section: Discussionsupporting

confidence: 93%

Provision and financial burden of TB services in a financially decentralized system: a case study from Shandong, China

Meng

Cheng

et al. 2004

Int. J. Health Plann. Mgmt.

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“…Similar economic factors affecting health-seeking behaviour have also been reported in Uganda (Saunderson 1995). Economic difficulties experienced during case holding have been also reported by patients and HCWs in some settings (Pocock et al 1996;Bevan 1997). In fact, some studies show that those receiving material support or having better economic conditions have significantly higher rates of treatment adherence (Farmer et al 1991;Barnhoorn & Adriaanse 1992).…”

Section: Discussionsupporting

confidence: 67%

Pulmonary tuberculosis and health‐seeking behaviour: how to get a delayed diagnosis in Cali, Colombia

Jaramillo

1998

Tropical Med Int Health

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SummaryTuberculosis is a heavy burden in the developing countries. Early diagnosis and adherence to treatment are difficult to achieve by patients. Our qualitative research looked at the paths followed and the barriers experienced by patients at the health care services of Cali, Colombia, while seeking help for pulmonary tuberculosis symptoms. Results show that the cultural-based explanation patients give to the symptoms, the stigma attached to the disease, and the poor quality of health care services (communication skills, organizational structure, attitudes, and knowledge of the tuberculosis control strategy of health care workers) are strong barriers to early diagnosis.keywords pulmonary tuberculosis, health-seeking behaviour, diagnosis correspondence Ernesto Jaramillo, Education and International Development

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“…Five studies reported medication costs that ranged from I$20 in Uganda [46] to I$548 in Nigeria [42] (see Table 4). Moreover, one study from Kenya reported that patients paid I$46 monthly for syringes and needles for streptomycin treatment (not including streptomycin itself) [43]. Three studies reported diagnostic test costs other than sputum smears which ranged from I$7 for chest radiographs [41] to I$10 for examination, laboratory, and X-ray fees in Tanzania [68].…”

Section: Resultsmentioning

confidence: 99%

Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa – a systematic review

et al. 2012

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BackgroundTuberculosis (TB) is known to disproportionately affect the most economically disadvantaged strata of society. Many studies have assessed the association between poverty and TB, but only a few have assessed the direct financial burden TB treatment and care can place on households. Patient costs can be particularly burdensome for TB-affected households in sub-Saharan Africa where poverty levels are high; these costs include the direct costs of medical and non-medical expenditures and the indirect costs of time utilizing healthcare or lost wages. In order to comprehensively assess the existing evidence on the costs that TB patients incur, we undertook a systematic review of the literature.MethodsPubMed, EMBASE, Science Citation Index, Social Science Citation Index, EconLit, Dissertation Abstracts, CINAHL, and Sociological Abstracts databases were searched, and 5,114 articles were identified. Articles were included in the final review if they contained a quantitative measure of direct or indirect patient costs for treatment or care for pulmonary TB in sub-Saharan Africa and were published from January 1, 1994 to Dec 31, 2010. Cost data were extracted from each study and converted to 2010 international dollars (I$).ResultsThirty articles met all of the inclusion criteria. Twenty-one studies reported both direct and indirect costs; eight studies reported only direct costs; and one study reported only indirect costs. Depending on type of costs, costs varied from less than I$1 to almost I$600 or from a small fraction of mean monthly income for average annual income earners to over 10 times average annual income for income earners in the income-poorest 20% of the population. Out of the eleven types of TB patient costs identified in this review, the costs for hospitalization, medication, transportation, and care in the private sector were largest.ConclusionTB patients and households in sub-Saharan Africa often incurred high costs when utilizing TB treatment and care, both within and outside of Directly Observed Therapy Short-course (DOTS) programs. For many households, TB treatment and care-related costs were considered to be catastrophic because the patient costs incurred commonly amounted to 10% or more of per capita incomes in the countries where the primary studies included in this review were conducted. Our results suggest that policies to decrease direct and indirect TB patient costs are urgently needed to prevent poverty due to TB treatment and care for those affected by the disease.

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Tuberculosis treatment is expensive for patients in developing countries

Cited by 8 publications

References 1 publication

Provision and financial burden of TB services in a financially decentralized system: a case study from Shandong, China

Provision and financial burden of TB services in a financially decentralized system: a case study from Shandong, China

Pulmonary tuberculosis and health‐seeking behaviour: how to get a delayed diagnosis in Cali, Colombia

Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa – a systematic review

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