Patients direct costs to undergo TB diagnosis.
Patients direct costs to undergo TB diagnosis.
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DOI：
10.1186/s40249-016-0117-x
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发表时间：
2016-03-24
影响因子：
8.1
通讯作者：
Cuevas LE
中科院分区：
文献类型：
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作者：
de Cuevas RM;Lawson L;Al-Sonboli N;Al-Aghbari N;Arbide I;Sherchand JB;Nnamdi EE;Aseffa A;Yassin MA;Abdurrahman ST;Obasanya J;Olanrewaju O;Datiko D;Theobald SJ;Ramsay A;Squire SB;Cuevas LE
结核病治疗的一个主要障碍是需要多次就诊的诊断过程。与诊断相关的患者费用的描述使用不同的方案，并且不具有可比性。我们的目的是描述成年人到四个国家的结核病诊断中心就诊的直接费用以及与诊断费用相关的因素。对尼日利亚、尼泊尔、埃塞俄比亚和也门的2225名成年人进行了调查。年龄18岁、咳嗽2周的成人作为前瞻性研究对象。使用结构化问卷对直接成本进行量化。具有成本第75个四分位数的患者被认为具有高支出(病例)，并与具有成本<；75个四分位数的患者进行比较，以确定与高支出相关的因素。最重要的支出是诊疗费和交通费。大多数参与者在同伴的陪同下参加了中心。高支出与陪伴、居住在农村地区/其他城镇和文盲有关。患者产生的费用是巨大的，各国之间存在共同的模式。取消用户费用、透明的收费政策和报销诊所费用将减少直接诊断费用的致贫效应。在资源有限的地方，可以优先支持那些面临高支出风险的人；那些不识字的人，与公司和农村居民一起参加服务。本文的在线版本(doi：10.1186/s40249-0160117-x)包含补充材料，可供授权用户使用。
A major impediment to the treatment of TB is a diagnostic process that requires multiple visits. Descriptions of patient costs associated with diagnosis use different protocols and are not comparable. We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis. Surveys of 2225 adults attending smear-microscopy centres in Nigeria, Nepal, Ethiopia and Yemen. Adults >18 years with cough >2 weeks were enrolled prospectively. Direct costs were quantified using structured questionnaires. Patients with costs >75th quartile were considered to have high expenditure (cases) and compared with patients with costs <75th quartile to identify factors associated with high expenditure. The most significant expenses were due to clinic fees and transport. Most participants attended the centres with companions. High expenditure was associated with attending with company, residing in rural areas/other towns and illiteracy. The costs incurred by patients are substantial and share common patterns across countries. Removing user fees, transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs. In locations with limited resources, support could be prioritised for those most at risk of high expenditure; those who are illiterate, attend the service with company and rural residents. The online version of this article (doi:10.1186/s40249-016-0117-x) contains supplementary material, which is available to authorized users.