Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India
Background: The average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from $55 to $8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016–2035) is that...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2018-01-01
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| Series: | Global Health Action |
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| Online Access: | http://dx.doi.org/10.1080/16549716.2018.1477493 |
| _version_ | 1811263137678098432 |
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| author | Thirunavukkarasu Prasanna Kathiresan Jeyashree Palanivel Chinnakali Yogesh Bahurupi Kavita Vasudevan Mrinalini Das |
| author_facet | Thirunavukkarasu Prasanna Kathiresan Jeyashree Palanivel Chinnakali Yogesh Bahurupi Kavita Vasudevan Mrinalini Das |
| author_sort | Thirunavukkarasu Prasanna |
| collection | DOAJ |
| description | Background: The average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from $55 to $8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016–2035) is that no TB-affected household suffers catastrophic costs due to TB. Study setting was free care under national tuberculosis program (NTP), Puducherry district, India. Objectives: The objectives of the study were among the newly diagnosed and previously treated tuberculosis (TB) patients, to (a) estimate patient costs during diagnosis and intensive phase of treatment, (b) determine the proportion of households experiencing catastrophic costs, and (c) explore coping strategies. Methods: An explanatory mixed methods design comprising both quantitative cost description and qualitative descriptive component was used. Catastrophic cost was defined as total TB care costs exceeding 20% of annual household income. Results: Of 102 TB patients included, two-thirds (69%) were male, 6% were HIV positive, and 45% reported at least one episode of hospitalization for TB care. The median (IQR) total cost of TB care was US$195 (52.1, 492.9) with a direct cost of US$65.3 (22.3, 156.5) and indirect cost of US$50.2 (0.9, 295.1). Overall, 32.4% of households experienced catastrophic costs due to TB care, significantly higher in patients with HIV coinfection (p = 0.009) and hospitalization (p = 0.009). Pledging jewels and borrowing money were major coping strategies. Cash assistance was the expected remedy from the patient perspective. Conclusion: Despite free TB care under NTP, more than a third incurred catastrophic costs towards TB care. |
| first_indexed | 2024-04-12T19:39:21Z |
| format | Article |
| id | doaj.art-019252c921424325a9dde529758180cc |
| institution | Directory Open Access Journal |
| issn | 1654-9716 1654-9880 |
| language | English |
| last_indexed | 2024-04-12T19:39:21Z |
| publishDate | 2018-01-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Global Health Action |
| spelling | doaj.art-019252c921424325a9dde529758180cc2022-12-22T03:19:07ZengTaylor & Francis GroupGlobal Health Action1654-97161654-98802018-01-0111110.1080/16549716.2018.14774931477493Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, IndiaThirunavukkarasu Prasanna0Kathiresan Jeyashree1Palanivel Chinnakali2Yogesh Bahurupi3Kavita Vasudevan4Mrinalini Das5All India Institute of Medical SciencesVelammal Medical College Hospital and Research InstituteJawaharlal Institute of Postgraduate Medical Education and ResearchIndira Gandhi Medical College and Research Institute, Govt. of Puducherry InstitutionIndira Gandhi Medical College and Research Institute, Govt. of Puducherry InstitutionMédecins Sans Frontières (MSF)/Doctors Without BordersBackground: The average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from $55 to $8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016–2035) is that no TB-affected household suffers catastrophic costs due to TB. Study setting was free care under national tuberculosis program (NTP), Puducherry district, India. Objectives: The objectives of the study were among the newly diagnosed and previously treated tuberculosis (TB) patients, to (a) estimate patient costs during diagnosis and intensive phase of treatment, (b) determine the proportion of households experiencing catastrophic costs, and (c) explore coping strategies. Methods: An explanatory mixed methods design comprising both quantitative cost description and qualitative descriptive component was used. Catastrophic cost was defined as total TB care costs exceeding 20% of annual household income. Results: Of 102 TB patients included, two-thirds (69%) were male, 6% were HIV positive, and 45% reported at least one episode of hospitalization for TB care. The median (IQR) total cost of TB care was US$195 (52.1, 492.9) with a direct cost of US$65.3 (22.3, 156.5) and indirect cost of US$50.2 (0.9, 295.1). Overall, 32.4% of households experienced catastrophic costs due to TB care, significantly higher in patients with HIV coinfection (p = 0.009) and hospitalization (p = 0.009). Pledging jewels and borrowing money were major coping strategies. Cash assistance was the expected remedy from the patient perspective. Conclusion: Despite free TB care under NTP, more than a third incurred catastrophic costs towards TB care.http://dx.doi.org/10.1080/16549716.2018.1477493health expenditurecoping strategypatient costsSORT-IT |
| spellingShingle | Thirunavukkarasu Prasanna Kathiresan Jeyashree Palanivel Chinnakali Yogesh Bahurupi Kavita Vasudevan Mrinalini Das Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India Global Health Action health expenditure coping strategy patient costs SORT-IT |
| title | Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India |
| title_full | Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India |
| title_fullStr | Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India |
| title_full_unstemmed | Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India |
| title_short | Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India |
| title_sort | catastrophic costs of tuberculosis care a mixed methods study from puducherry india |
| topic | health expenditure coping strategy patient costs SORT-IT |
| url | http://dx.doi.org/10.1080/16549716.2018.1477493 |
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