The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal
The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal
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DOI：
10.1186/s40249-019-0603-z
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发表时间：
2019-12-03
影响因子：
8.1
通讯作者：
de Siqueira-Filha, Noemia Teixeira
中科院分区：
文献类型：
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作者：
Gurung, Suman Chandra;Dixit, Kritika;de Siqueira-Filha, Noemia Teixeira
背景世界卫生组织（WHO）终结结核病战略确立了一个里程碑，即到2020年将面临灾难性成本的结核病影响家庭数量减少到零。主动病例发现（ACF）在降低患者成本方面的作用尚未在全球范围内确定。因此，本研究旨在比较通过ACF和被动病例发现（PCF）诊断的结核病患者所产生的费用，并确定尼泊尔患者所产生的灾难性费用的患病率和强度。方法该研究于2018年6月至8月在尼泊尔的两个地区进行：巴尔迪亚和皮坦（第5省）。本研究以1：1的比例纳入了100例患者（PCF：ACF，每个地区25例连续ACF和25例连续PCF患者）。世卫组织结核病患者成本计算工具用于从患者或其家庭成员收集有关间接和直接医疗和非医疗费用的信息。灾难性成本是根据总成本超过家庭年收入20%的患者比例计算的。使用正超调方法计算灾难性成本的强度。卡方检验和Wilcoxon-Mann-Whitney检验用于比较比例和成本。同时，进行Mantel Haenszel检验以评估灾难性成本与诊断类型之间的关联。结果采访了99名患者（50名ACF和49名PCF）。通过ACF诊断的患者在治疗前阶段的费用较低（直接医疗：14美元vs 32美元，P = 0.001;直接非医疗：3美元vs 10美元，P = 0.004;间接时间损失：4美元vs 13美元，P < 0.001）。在ACF患者中，治疗前和强化阶段的直接医疗费用（15美元vs 34美元，P = 0.002）和非医疗费用（30美元vs 54美元，P = 0.022）也较低。对于所有阈值，ACF患者灾难性直接成本的发生率较低。ACF患者的灾难性成本强度也较低，尽管差异无统计学意义。结论ACF可以显著降低患者的费用，有助于实现终结结核病战略的目标。还需要执行其他协同政策，如社会保障，以将结核病患者家庭的灾难性成本降至零。
Background The World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal. Methods The study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income. The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis. Results Ninety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32, P = 0.001; direct non-medical: USD 3 vs USD 10, P = 0.004; indirect, time loss: USD 4 vs USD 13, P < 0.001). The cost of the pre-treatment and intensive phases combined was also lower for direct medical (USD 15 vs USD 34, P = 0.002) and non-medical (USD 30 vs USD 54, P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant. Conclusions ACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.