Household costs of illness during different phases of tuberculosis treatment in Central Asia: a patient survey in Tajikistan
Household costs of illness during different phases of tuberculosis treatment in Central Asia: a patient survey in Tajikistan
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DOI：
10.1186/1471-2458-10-18
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发表时间：
2010-01-18
影响因子：
4.5
通讯作者：
Saidaliev, Sadullo
中科院分区：
文献类型：
--
作者：
Aye, Raffael;Wyss, Kaspar;Saidaliev, Sadullo
背景：患者产生的疾病相关费用构成了家庭的严重经济负担，特别是在低收入国家。高昂的家庭疾病费用导致负担过重;它们损害了医疗保健的可负担性和公平获得性，从而阻碍了结核病的控制。到目前为止，还没有研究调查病人的结核病成本在前苏联。方法：所有成年新的肺结核病例纳入DOTS计划在12个研究区在研究期间进行了登记。医疗和非医疗支出以及收入损失在两个不同时期的访谈中进行了量化。将不同项目的成本相加以计算总成本。结果：204例DOTS患者（男性114例，女性90例）参加了问卷调查。结核病发作的总疾病费用平均为1053美元（c。4900美元购买力平价，购买力平价），其中292美元，338美元和422美元分别出现在治疗开始前，在强化阶段和继续阶段。每月费用在治疗开始前（145美元）和强化阶段（153美元）最高，在继续阶段（95美元）较低。这些差异是非常显着的（配对t检验，p < 0.0005的两个比较）。结论：结核病发作的疾病相关成本超过人均国内生产总值1600美元购买力平价约2.5倍。因此，这些费用对有关家庭来说是灾难性的，并意味着很高的破产风险。费用并不是平均分摊的，而是在治疗的早期阶段达到高峰，加剧了负担能力的问题。为了控制塔吉克斯坦的结核病，需要采取缓解战略，其中可能包括对患者的社会支持以及改变结核病病例的管理。这些缓解策略应在治疗的早期，当成本负担最高时进行。
Background: Illness-related costs incurred by patients constitute a severe economic burden for households especially in low-income countries. High household costs of illness lead to impoverishment; they impair affordability and equitable access to health care and consequently hamper tuberculosis (TB) control. So far, no study has investigated patient costs of TB in the former Soviet Union.Methods: All adult new pulmonary TB cases enrolled into the DOTS program in 12 study districts during the study period were enrolled. Medical and non-medical expenditure as well as loss of income were quantified in two interviews covering separate time periods. Costs of different items were summed up to calculate total costs. For missing values, multiple imputation was applied.Results: A cohort of 204 patients under DOTS, 114 men and 90 women, participated in the questionnaire survey. Total illness costs of a TB episode averaged $1053 (c. $4900 purchasing power parity, PPP), of which $292, $338 and $422 were encountered before the start of treatment, during intensive phase and in continuation phase, respectively. Costs per month were highest before the start of treatment ($145) and during intensive phase ($153) and lower during continuation phase ($95). These differences were highly significant (paired t-test, p < 0.0005 for both comparisons).Conclusions: The illness-related costs of an episode of TB exceed the per capita GDP of $1600 PPP about two-and-a-half times. Hence, these costs are catastrophic for concerned households and suggest a high risk for impoverishment. Costs are not equally spread over time, but peak in early stages of treatment, exacerbating the problem of affordability. Mitigation strategies are needed in order to control TB in Tajikistan and may include social support to the patients as well as changes in the management of TB cases. These mitigation strategies should be timed early in treatment when the cost burden is highest.