Tuberculosis in Salvador, Brazil: costs to health system and families (original) (raw)
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Economic Burden of Tuberculosis for Patients and their Households in Cochabamba, Bolivia
Journal of Community Medicine & Public Health, 2021
Background: Patients with tuberculosis (TB) usually incur large costs directly related to their disease. Additional indirect costs also increase the economic burden of households creating barriers of access and adherence that can affect the healing of patients. Because TB affects the poorest segment of society the effects can be more serious for poor people. Indirect costs are poorly documented in Bolivia. We therefore conducted a study to determine the socioeconomic impact of TB on patients and their households. Methods: A cross-sectional survey was carried out on 2017 in the Department of Cochabamba, Bolivia, included all patients who were on TB treatment within the health network. The generic survey instrument proposed by WHO for tuberculosis patients cost surveys was used. The most important direct medical and direct non-medical payments were calculated in a disaggregated manner. The calculation of indirect costs was carried out through the results-based approach where the loss of income was calculated from the report of household income. Catastrophic cost was determined and multivariable logistic regression was run to assess which factors were independently associated with a total catastrophic cost experienced by a TB patient. Results: The indirect costs during an entire illness episode had a median of USD 768.1 corresponding to 63.4% of the total cost for all patients. In the case of multidrug-resistant TB (MDR TB) patients, the median cost was USD 6454.8 corresponding to 54.3% of their total costs. Direct non-medical costs had a median for all patients of USD 408.7 (33.7%), and of USD 5399.6 (45.4%) for MDR TB patients. The most important non-medical costs were those linked to directly observed treatment (DOT) with a median of USD 419.8 during intensive phase and of USD 108.6 during continuation phase for transport costs. Food and drinks costs had a median of USD 94.5 during intensive phase and of USD 54.8 during continuation phase; consumption of nutritional supplements had a median cost of USD 249.1 and additional food outside the regular diet had a median cost of USD 519 for all patients. Catastrophic costs were incurred by 43.9% of TB patients. These catastrophic costs were observed in 50% of the population aged over 55 years, in 60% of MDR-TB patients, and in 63% of poor patients. Using logistic regression, factors associated with a higher risk of catastrophic costs were to live in an urban province (OR = 1.82 95%CI 1.11 to 2.98, P = 0.002), to be older than 55 years (OR = 1.21 95%CI: 1.07 to 1.38, P = 0.005), and to have a low economic income (OR = 0.83 95%CI: 0.69 to 0.99, P = 0.049). Conclusions: Patients with TB treated in health services of Bolivia face a great financial burden. Indirect costs were higher than direct costs in a complete TB episode, especially in MDR-TB patients. During the treatment, the most important costs were those related to transport and food when patients went to DOT; nutritional supplements and additional food to the regular diet accounted also for a non-negligible cost. Almost half of patients suffer a catastrophic cost, especially those who came from an urban province, those who were older than 55 years, and those having a low economic income.
Catastrophic costs and social sequels due to tuberculosis diagnosis and treatment in Brazil
Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil, 2021
OBJECTIVE To evaluate the impact of catastrophic costs on unfavorable tuberculosis treatment outcomes. METHODS This was a prospective cohort study, conducted in five Brazilian state capitals (Manaus, Recife, Vitória, Campo Grande and Porto Alegre) from June 2016 to July 2018. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (95%CI). RESULTS Of the 350 participants, 310 were included, of whom 30 presented unfavorable outcomes. Catastrophic cost (OR=2.53 -95% CI 1.13;5.67) and divorce (OR=5.29 -95% CI 1.39;20.05) increased the chances of unfavorable outcomes. CONCLUSION Financial difficulties during tuberculosis treatment may impair its outcome. Catastrophic cost and divorce were determining factors for treatment outcomes.
PLOS ONE, 2023
Background One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a baseline, the magnitude and main drivers of the costs associated with TB disease for patients and their households and to monitor the proportion of households experiencing catastrophic costs in Brazil. Methods A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors (<18 years old) were interviewed once about costs, time loss, coping measures, income, household expenses, and asset ownership. Total costs, including indirect costs measured as reported household income change, were expressed as a percentage of annual household income. We used descriptive statistics to analyze the cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs. Results We interviewed 603 patients, including 538 (89%) with drug-sensitive (DS) and 65 (11%) with drug-resistant (DR) TB. Of 603 affected households, 48.1% (95%CI: 43-53.2)
Revista Panamericana de Salud Pública, 2013
OBJECTIVE: To examine direct and indirect costs incurred by new, retreatment, and multidrug-resistant (MDR) tuberculosis (TB) patients in the Dominican Republic before and during diagnosis, and during treatment, to generate an evidence base and formulate recommendations. METHODS: The "Tool to Estimate Patients' Costs" was adapted to the local setting, translated into Spanish, and pretested. Patients attending 32 randomly selected health facilities in six chosen study areas on the study days were interviewed. Responses from patients 18-65 years old who had received treatment for at least one month and provided signed informed consent were collected, entered into a database, and analyzed. RESULTS: A total of 200 patients were interviewed. For most respondents, direct and indirect costs increased while income decreased. Total costs amounted to a median of US$ 908 for new patients, US$ 432 for retreatment patients, and US$ 3 557 for MDR-TB patients. The proportion of patie...
Revista Panamericana de Salud Pública, 2013
Objective. To examine direct and indirect costs incurred by new, retreatment, and multidrug-resistant (MDR) tuberculosis (TB) patients in the Dominican Republic before and during diagnosis, and during treatment, to generate an evidence base and formulate recommendations. Methods. The "Tool to Estimate Patients' Costs" was adapted to the local setting, translated into Spanish, and pretested. Patients attending 32 randomly selected health facilities in six chosen study areas on the study days were interviewed. Responses from patients 18-65 years old who had received treatment for at least one month and provided signed informed consent were collected, entered into a database, and analyzed. Results. A total of 200 patients were interviewed. For most respondents, direct and indirect costs increased while income decreased.
Escola Anna Nery, 2018
Introduction: Tuberculosis is historically associated with poverty, generating costs that can influence treatment. Considering the impact of the costs of illness, the importance of adapting the instrument is highlighted. Objective: To adapt transculturally to Brazilian Portuguese the instrument Tool to Estimate Patient's Costs. Methods: Study of the type transcultural adaptation of instrument. The translation followed the criteria described by Herdman, 1998, in order to preserve functional equivalence as much as possible. The questionnaire with cross-cultural adaptation was applied to 77 patients, with at least one full month of treatment for the disease. Results: Instrument was shown with Cronbach Alpha above 0.71 constituting a good tool for measuring the costs of the disease, being necessary modifications. Conclusions: This study suggests the creation of an instrument adapted for the treatment of TB in Brazil, for the evaluation of costs with the illness by tuberculosis.
The rising number of tuberculosis cases is putting a considerable strain on health budgets, and threatens to drain resources essential to health and welfare services. Objectives: The objective of this study was to estimate the costs of tuberculosis to outpatients and their families in a rural district health center, Addet Health Center, Yilmana Densa District, Amhara National Regional State in Ethiopia. Methods: Cross-sectional study was conducted to estimate the costs of tuberculosis to outpatients and their families. Data were collected on diagnosis, treatment, transportation, food and other expenses, and also income losses due to tuberculosis before and after the diagnosis of tuberculosis. Data were entered to Epi-Info and transferred to SPSS 13 for analysis. Mean, median, range and standard deviation were used to describe the data. Result: The mean direct cost and indirect cost of tuberculosis to outpatients and their families were 1078.00 Birr and 2080.43 Birr, respectively. The mean total cost of tuberculosis to outpatients and their families was 3159.23 Birr. Conclusion: Cost of tuberculosis to patients and their families, especially before the identification of the disease was found to be very high. Therefore, consequences of tuberculosis to patients and their families are particularly serious and potentially devastating.