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Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India

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Title: Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India
Authors: Kathiresan Jeyashree, Jeromie W. V. Thangaraj, Devika Shanmugasundaram, Sri Lakshmi Priya Giridharan, Sumit Pandey, Prema Shanmugasundaram, Sabarinathan Ramasamy, Venkateshprabhu Janagaraj, Sivavallinathan Arunachalam, Rahul Sharma, Vaibhav Shah, Bhavani Shankara Bagepally, Joshua Chadwick, Hemant Deepak Shewade, Aniket Chowdhury, Swati Iyer, Raghuram Rao, Sanjay K. Mattoo, Manoj V. Murhekar
Source: Global Health Research and Policy, Vol 9, Iss 1, Pp 1-13 (2024)
Publisher Information: BMC, 2024.
Publication Year: 2024
Collection: LCC:Public aspects of medicine
Subject Terms: Costs of TB care, Catastrophic costs, Direct costs, Indirect costs, India, Public aspects of medicine, RA1-1270
More Details: Abstract Background Tuberculosis (TB) poses a significant social and economic burden to households of persons with TB (PwTB). Despite free diagnosis and care under the National TB Elimination Programme (NTEP), individuals often experience significant out-of-pocket expenditure and lost productivity, causing financial catastrophe. We estimated the costs incurred by the PwTB during TB care and identified the factors associated with the costs. Methods In our cross-sectional study, we used multi-stage sampling to select PwTB notified under the NTEP, whose treatment outcome was declared between May 2022 and February 2023. Total patient costs were measured through direct medical, non-medical and indirect costs. Catastrophic costs were defined as expenditure on TB care > 20% of the annual household income. We determined the factors influencing the total cost of TB care using median regression. We plotted concentration curves to depict the equity in distribution of catastrophic costs across income quintiles. We used a cluster-adjusted, generalized model to determine the factors associated with catastrophic costs. Results The mean (SD) age of the 1407 PwTB interviewed was 40.8 (16.8) years. Among them, 865 (61.5%) were male, and 786 (55.9%) were economically active. Thirty-four (2.4%) had Drug Resistant TB (DRTB), and 258 (18.3%) had been hospitalized for TB. The median (Interquartile range [IQR] and 95% confidence interval [CI]) of total costs of TB care was US$386.1 (130.8, 876.9). Direct costs accounted for 34% of the total costs, with a median of US$78.4 (43.3, 153.6), while indirect costs had a median of US$279.8 (18.9,699.4). PwTB
Document Type: article
File Description: electronic resource
Language: English
ISSN: 2397-0642
Relation: https://doaj.org/toc/2397-0642
DOI: 10.1186/s41256-024-00392-9
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  Data: Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India
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  Data: Abstract Background Tuberculosis (TB) poses a significant social and economic burden to households of persons with TB (PwTB). Despite free diagnosis and care under the National TB Elimination Programme (NTEP), individuals often experience significant out-of-pocket expenditure and lost productivity, causing financial catastrophe. We estimated the costs incurred by the PwTB during TB care and identified the factors associated with the costs. Methods In our cross-sectional study, we used multi-stage sampling to select PwTB notified under the NTEP, whose treatment outcome was declared between May 2022 and February 2023. Total patient costs were measured through direct medical, non-medical and indirect costs. Catastrophic costs were defined as expenditure on TB care > 20% of the annual household income. We determined the factors influencing the total cost of TB care using median regression. We plotted concentration curves to depict the equity in distribution of catastrophic costs across income quintiles. We used a cluster-adjusted, generalized model to determine the factors associated with catastrophic costs. Results The mean (SD) age of the 1407 PwTB interviewed was 40.8 (16.8) years. Among them, 865 (61.5%) were male, and 786 (55.9%) were economically active. Thirty-four (2.4%) had Drug Resistant TB (DRTB), and 258 (18.3%) had been hospitalized for TB. The median (Interquartile range [IQR] and 95% confidence interval [CI]) of total costs of TB care was US$386.1 (130.8, 876.9). Direct costs accounted for 34% of the total costs, with a median of US$78.4 (43.3, 153.6), while indirect costs had a median of US$279.8 (18.9,699.4). PwTB
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