Cost of tuberculosis diagnosis and treatment from the patient perspective in Lusaka, Zambia (original) (raw)

Abstract

O B J E C T I V E S : 1) To estimate patient costs for tuberculosis (TB) diagnosis and treatment and 2) to identify determinants of patient costs. M E T H O D S : A cross-sectional survey of 103 adult TB patients who had been on treatment for 1–3 months was conducted using a standardised questionnaire. Direct and indirect costs were estimated, converted into US$ and categorised into two time periods: 'pre-diagnosis/ care-seeking' and 'post-diagnosis/treatment'. Determinants of patient costs were analysed using multiple linear regression. R E S U LT S : The median total patient costs for diagnosis and 2 months of treatment was $24.78 (interquartile range 13.56– 40.30) per patient—equivalent to 47.8% of patients' median monthly income. Sex, patient delays in seeking care and method of treatment supervision were signifi cant predictors of total patient costs. The total direct costs as a proportion of income were higher for women than men (P < 0.001). Treatment costs incurred by patients on the clinic-based directly observed treatment strategy were more than three times greater than those incurred by patients on the self-administered treatment strategy (P < 0.001). C O N C L U S I O N : Clinic-based treatment supervision posed a signifi cant economic burden on patients. The creation or strengthening of community-based treatment supervision programmes would have the greatest potential impact on reducing patients' TB-related costs. K E Y W O R D

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References (31)

  1. Corbett E L, Marston B, Churchyard G J, De Cock K M. Tu- berculosis in sub-Saharan Africa: opportunities, challenges and change in the era of antiretroviral treatment. Lancet 2006; 367: 926-937.
  2. World Health Organization. Global tuberculosis control- surveillance, planning, fi nancing, 2006. WHO/HTM/STB/2006. 37. Geneva, Switzerland: WHO, 2006.
  3. Joint United Nations Programme on HIV/AIDS. Report on the global HIV/AIDS epidemic. Geneva, Switzerland: UNAIDS, 2006. http://data.unaids.org/pub/GlobalReport/2006/2006\_GR\_ ANN2_en.pdf Accessed May 2008.
  4. Government of Zambia. National TB reporting database. Lu- saka, Zambia: Government of Zambia, 2006.
  5. Mwaba P, Maboshe M, Chintu C, et al. The relentless spread of tuberculosis in Zambia-trends over the past 37 years (1964- 2000). S Afr Med J 2003; 93: 149-152.
  6. 6 Godfrey-Faussett P, Ayles H. Can we control tuberculosis in high HIV prevalence settings? Tuberculosis 2003; 83: 68-76.
  7. Corbett E L, Watt C J, Walker N, et al. The growing burden of tuberculosis: global trends and interactions with the HIV epi- demic. Arch Internal Med 2003; 163: 1009-1021.
  8. Floyd K, Wilkinson D. Tuberculosis in the HIV/AIDS era: inter- actions, impacts and solutions. AIDS Analysis Africa 1997; 7: 5-7.
  9. Ogden J. The resurgence of tuberculosis in the tropics. Improv- ing tuberculosis control-social science inputs. Trans Roy Soc Trop Med Hygiene 2000; 94: 135-140.
  10. Floyd K, Blanc L, Raviglione M, Lee J W. Resources required for global tuberculosis control. Science 2002; 295: 2040- 2041.
  11. McIntyre D, Thiede M, Dahlgren G, Whitehead M. What are the economic consequences for households of illness and of pay- ing for health care in low-and middle-income country contexts? Soc Sci Med 2006; 62: 858-865.
  12. Walker D, McNerney R, Mwembo M K, Foster S, Tihon V, Godfrey-Faussett P. An incremental cost-effectiveness analysis of the fi rst, second and third sputum examination in the diag- nosis of pulmonary tuberculosis. Int J Tuberc Lung Dis 2000; 4: 246-251.
  13. Lusaka District Health Management Board. Action plan and budget for the years: 2006-2008. Lusaka, Zambia: Lusaka Dis- trict Health Management Board, 2006.
  14. World Health Organization. An expanded DOTS framework for effective tuberculosis control. Geneva, Switzerland. WHO, 2002.
  15. Maher D. Community contribution to TB care: policy and prac- tice. Geneva, Switzerland. WHO, 2003.
  16. Schwartzman K, Oxlade O, Barr R G, et al. Domestic returns from investment in the control of tuberculosis in other coun- tries. N Engl J Med 2005; 353: 1008-1020.
  17. 17 Ministry of Finance and National Planning. Economic report 2001. Lusaka, Zambia: Ministry of Finance and National Plan- ning, 2002.
  18. Fox-Rushby J, Cairns J. Economic evaluation. 1st ed. Oxford, UK: Oxford University Press, 2005.
  19. Russell S. The economic burden of illness for households in de- veloping countries: a review of studies focusing on malaria, tu- berculosis and human immunodefi ciency virus/acquired immuno- defi ciency syndrome. Am J Trop Med Hygiene 2004; 7 (Suppl 2): S147-S155.
  20. Floyd K. Costs and effectiveness-the impact of economic stud- ies on TB control. Tuberculosis 2003; 83: 187-200.
  21. Floyd K, Skeva J, Nyirenda T, Gausi F, Salaniponi F. Cost and cost-effectiveness of increased community and primary care fa- cility involvement in tuberculosis care in Lilongwe District, Ma- lawi. Int J Tuberc Lung Dis 2003; 7 (Suppl 1): S29-S37.
  22. Fryatt R J. Review of published cost-effectiveness studies on tu- berculosis treatment programmes. Int J Tuberc Lung Dis 1997; 1: 101-109.
  23. Nganda B, Wang'ombe J, Floyd K, Kangangi J. Cost and cost- effectiveness of increased community and primary care facility involvement in tuberculosis care in Machakos District, Kenya. Int J Tuberc Lung Dis 2003; 7 (Suppl 1): S14-S20.
  24. Okello D, Floyd K, Adatu F, Odeke R, Gargioni G. Cost and cost-effectiveness of community-based care for tuberculosis pa- tients in rural Uganda. Int J Tuberc Lung Dis 2003; 7 (Suppl 1): S72-S79.
  25. Sinanovic E, Floyd K, Dudley L, Azevedo V, Grant R, Maher D. Cost and cost-effectiveness of community-based care for tuber- culosis in Cape Town, South Africa. Int J Tuberc Lung Dis 2003; 7 (Suppl 1): S56-S62.
  26. Golub J E, Mohan C I, Comstock G W, Chaisson R E. Active case fi nding of tuberculosis: historical perspective and future prospects. Int J Tuberc Lung Dis 2005; 9: 1183-1203.
  27. CREATE Consortium, 2006. Baltimore, MD, USA: Create, 2006. www.tbhiv-create.org/ Accessed May 2008.
  28. Koop G. Analysis of economic data. 2nd ed. Leicester, UK: John Wiley & Sons, 2005.
  29. Needham D M, Godfrey-Faussett P, Foster S D. Barriers to tu- berculosis control in urban Zambia: the economic impact and burden on patients prior to diagnosis. Int J Tuberc Lung Dis 1998; 2: 811-817.
  30. Hjortsberg C A, Mwikisa C N. Cost of access to health services in Zambia. Health Policy Plan 2002; 17: 71-77.
  31. Blas E, Limbambala M. User-payment, decentralization and health service utilization in Zambia. Health Policy Plan 2001; 16 (Suppl 2): 19-28.