The economic burden of TB diagnosis and treatment in South Africa

Bibliographic Data

ID4842729
AuthorsNicola Foster (0000-0003-4630-6243, University of Cape Town, corresponding author), Anna Vassall (0000-0002-2911-1375, London School of Hygiene & Tropical Medicine), Susan Cleary (0000-0002-9071-7958, University of Cape Town), Lucy Cunnama (0000-0003-2134-4905, University of Cape Town), Gavin Churchyard (0000-0002-4269-3699, London School of Hygiene & Tropical Medicine), Edina Sinanovic (0000-0002-6783-0848, University of Cape Town)
Year2015
Volume130
Pages42-50
Publication date2015-04-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2015.01.046
PMID25681713
OpenAlexW2007344889
LanguageEN
Citations received28
References cited25

Social protection against the cost of illness is a central policy objective of Universal Health Coverage and the post-2015 Global strategy for Tuberculosis (TB). Understanding the economic burden associated with TB illness and care is key to identifying appropriate interventions towards achieving this target. The aims of this study were to identify points in patient pathways from start of TB symptoms to treatment completion where interventions could be targeted to reduce the economic impact on patients and households, and to identify those most vulnerable to these costs. Two cohorts of patients accessing TB services from ten clinics in four provinces in South Africa were surveyed between July 2012 and June 2013. One cohort of 351 people with suspected TB were interviewed at the point of receiving a TB diagnostic and followed up six months later. Another cohort of 168 patients on TB treatment, at the same ten facilities, was interviewed at two-months and five-months on treatment. Patients were asked about their health-seeking behaviour, associated costs, income loss, and coping strategies used. Patients incurred the greatest share of TB episode costs (41%) prior to starting treatment, with the largest portion of these costs being due to income loss. Poorer patients incurred higher direct costs during treatment than those who were less poor but only 5% of those interviewed were accessing cash-transfers during treatment. Indirect costs accounted for 52% of total episode cost. Despite free TB diagnosis and care in South Africa, patients incur substantial direct and indirect costs particularly prior to starting treatment. The poorest group of patients were incurring higher costs, with fewer resources to pay for it. Both the direct and indirect cost of illness should be taken into account when setting levels of financial protection and social support, to prevent TB illness from pushing the poor further into poverty

Business · Cohort · Economic cost · Economic growth · Environmental health · Health care · Indirect costs · Psychiatry · Psychological intervention · Public health · Tuberculosis · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Nursing · Tuberculosis Research and Epidemiology

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