Patient costs for drug-resistant TB diagnosis and pre-treatment evaluation in North India.

IF 1.3 Q4 RESPIRATORY SYSTEM

Public Health Action Pub Date : 2024-09-01 DOI:10.5588/pha.24.0018

S Das, R Kumar, A Krishnan, S Kant, A Mohan

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Abstract

Introduction: India's National TB Elimination Programme (NTEP) aims to eliminate TB-related catastrophic expenditure by offering free diagnosis and treatment. However, 3.9% of TB patients have drug-resistant TB (DR-TB) and are facing higher costs.

Objective: To assess DR-TB patients' diagnosis and pre-treatment evaluation costs, catastrophic cost incidence, and its relation to patient characteristics.

Methods: The study included DR-TB patients from three District Drug-Resistant TB Centres in Delhi and Faridabad (October 2021-June 2022). Socio-economic and clinical characteristics and direct medical and non-medical costs from drug susceptibility testing eligibility to the start of DR-TB treatment were collected using patient interviews and records. Indirect costs were calculated via the human capital approach, defining catastrophic costs as expenses over 20% of household annual income. Multivariable regression was used to estimate the effects of patient characteristics on catastrophic costs.

Results: Of 158 patients, 37.3% were aged 19-30 years, and 55.7% were women. Median total cost was USD326.6 (IQR 132.7-666.7), with 48.2% for diagnosis and 66.0% indirect. 32% faced catastrophic costs, with manual labourers at higher risk (adjusted OR 4.4).

Conclusion: Despite free diagnosis and treatment, a significant portion of DR-TB households in India incur catastrophic costs, mainly from indirect expenses, indicating a need for targeted policy and programme interventions.

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印度北部耐药性肺结核诊断和治疗前评估的患者费用。

导言：印度的国家消除结核病计划（NTEP）旨在通过提供免费诊断和治疗，消除与结核病相关的灾难性开支。然而，3.9% 的肺结核病人患有耐药性肺结核（DR-TB），面临着更高的费用：评估 DR-TB 患者的诊断和治疗前评估费用、灾难性费用发生率及其与患者特征的关系：研究对象包括德里和法里达巴德三个地区耐药结核病中心的 DR-TB 患者（2021 年 10 月至 2022 年 6 月）。通过对患者的访谈和记录，收集了从药敏试验合格到开始 DR-TB 治疗期间的社会经济和临床特征以及直接医疗和非医疗成本。间接成本通过人力资本法进行计算，灾难性成本定义为超过家庭年收入 20% 的支出。采用多变量回归法估算了患者特征对灾难性费用的影响：在 158 名患者中，37.3% 年龄在 19-30 岁之间，55.7% 为女性。总费用中位数为 326.6 美元（IQR 为 132.7-666.7 美元），其中 48.2% 用于诊断，66.0% 为间接费用。32%的人面临灾难性费用，体力劳动者的风险更高（调整后 OR 为 4.4）：尽管诊断和治疗是免费的，但印度仍有相当一部分 DR-TB 家庭要承担灾难性费用，主要是间接费用，这表明有必要采取有针对性的政策和计划干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.