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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...

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Autores principales: Prasanna, Thirunavukkarasu, Jeyashree, Kathiresan, Chinnakali, Palanivel, Bahurupi, Yogesh, Vasudevan, Kavita, Das, Mrinalini
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6008578/
https://www.ncbi.nlm.nih.gov/pubmed/29902134
http://dx.doi.org/10.1080/16549716.2018.1477493
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author Prasanna, Thirunavukkarasu
Jeyashree, Kathiresan
Chinnakali, Palanivel
Bahurupi, Yogesh
Vasudevan, Kavita
Das, Mrinalini
author_facet Prasanna, Thirunavukkarasu
Jeyashree, Kathiresan
Chinnakali, Palanivel
Bahurupi, Yogesh
Vasudevan, Kavita
Das, Mrinalini
author_sort Prasanna, Thirunavukkarasu
collection PubMed
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.
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spelling pubmed-60085782018-06-22 Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India Prasanna, Thirunavukkarasu Jeyashree, Kathiresan Chinnakali, Palanivel Bahurupi, Yogesh Vasudevan, Kavita Das, Mrinalini Glob Health Action Original Article 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. Taylor & Francis 2018-06-14 /pmc/articles/PMC6008578/ /pubmed/29902134 http://dx.doi.org/10.1080/16549716.2018.1477493 Text en © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Prasanna, Thirunavukkarasu
Jeyashree, Kathiresan
Chinnakali, Palanivel
Bahurupi, Yogesh
Vasudevan, Kavita
Das, Mrinalini
Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India
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 Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6008578/
https://www.ncbi.nlm.nih.gov/pubmed/29902134
http://dx.doi.org/10.1080/16549716.2018.1477493
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