Catastrophic costs for tuberculosis patients in India

Impact of methodological choices

Bibliographic Data

ID19594264
AuthorsSusmita Chatterjee (0000-0002-0937-7205, Manipal Academy of Higher Education, corresponding author), Palash Das (0000-0002-2643-3563, George Institute for Global Health, corresponding author), Guy Stallworthy (0000-0002-2414-774X, Gates Foundation, corresponding author), Gayatri Bhambure (0009-0005-2946-8592, George Institute for Global Health, corresponding author), Radha Munje (Government Medical College, corresponding author), Anna Vassall (0000-0002-2911-1375, London School of Hygiene & Tropical Medicine, corresponding author)
EditorsHabib Hasan Farooqui (0000-0002-3081-2929)
Year2024
Volume4
Issue4
Pagese0003078
Publication date2024-04-26
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0003078
PMID38669225
OpenAlexW4395662899
LanguageEN
Citations received5
References cited22

As financial risk protection is one of the goals towards universal health coverage, detailed information on costs, catastrophic costs and other economic consequences related to any disease are required for designing social protection measures. End Tuberculosis (TB) Strategy set a milestone of achieving zero catastrophic cost by 2020. However, a recent literature review noted that 7%-32% TB affected households in India faced catastrophic cost. Studies included in the review were small scale cross-sectional. We followed a cohort of 1482 notified drug-susceptible TB patients from four states in India: Assam, Maharashtra, Tamil Nadu, and West Bengal to provide a comprehensive picture of economic burden associated with TB treatment. Treatment cost was calculated using World Health Organization guidelines on TB patient cost survey and both human capital and output approaches of indirect cost (time, productivity, and income loss related to an episode) calculation were used to provide the range of households currently facing catastrophic cost. Depending on choice of indirect cost calculation method, 30%-61% study participants faced catastrophic cost. For over half of them, costs became catastrophic even before starting TB treatment as there was average 7–9 weeks delay from symptom onset to treatment initiation which was double the generally accepted delay of 4 weeks. During that period, they made average 8–11 visits to different providers and spent money on consultations, drugs, tests, and travel. Following the largest cohort of drug-susceptible TB patients till date, the study concluded that a significant proportion of study participants faced catastrophic cost and the proportion was much higher when income loss was considered as indirect cost calculation method. Therefore, ensuring uninterrupted livelihood during TB treatment is an absolute necessity. Another reason of high cost was the delay in diagnosis and costs incurred during pre-diagnosis period. This delay and consequently, economic burden, can be reduced by both supply side (intense private sector engagement, rapid diagnosis) and demand side (community engagement) initiatives. Reimbursement of expenses incurred before treatment initiation could be used as short-term measure for mitigating financial hardship

Business · Cohort · Economic cost · Economic growth · Economics · Environmental health · Indirect costs · Productivity · Total cost · Tuberculosis · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Tuberculosis Research and Epidemiology

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