Pre- and post-diagnosis costs of tuberculosis to patients on Directly Observed Treatment Short course in districts of southwestern Ethiopia: a longitudinal study
Pre- and post-diagnosis costs of tuberculosis to patients on Directly Observed Treatment Short course in districts of southwestern Ethiopia: a longitudinal study
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DOI：
10.1186/s41043-018-0146-0
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发表时间：
2018-05-21
影响因子：
1.9
通讯作者：
Deressa, Wakgari
中科院分区：
文献类型：
--
作者：
Asres, Abyot;Jerene, Degu;Deressa, Wakgari
背景：结核病患者的经济负担导致治疗延迟和依从性差。我们评估了结核病患者诊断前和诊断后的费用。方法：对埃塞俄比亚西南部10个州（区）2015年1月至2016年6月的735例新发结核病病例进行纵向研究。在前2个月和治疗结束时，向患者征求直接自付、付款和收入损失（间接成本）。因此，我们确定了患者在诊断前和诊断后期间发生的直接医疗、非医疗和间接费用。我们将从发病到结核病诊断发生的费用分类为诊断前费用，将诊断后到治疗完成发生的费用分类为诊断后费用。诊断前和诊断后的费用构成了患者的总费用。我们拟合线性回归模型来确定成本的预测因素。结果：在发病和抗结核治疗过程之间，患者的中位数（四分位数范围（IQR））为201.48美元（136.7-318.94）。间接成本和直接成本分别占总成本的70.6%和29.4%。结核病患者在诊断前和诊断后的中位数（IQR）分别为97.62美元（6.43-184.22）和93.75美元（56.91-141.54）。因此，患者在诊断前的费用占总费用的53.6%。诊断前和诊断后期间的直接自付费用中位数（IQR）分别为21.64美元（10.23-48.31）和35.02美元（0-70.04）。患者延迟天数（p < 0.001）、提供者延迟天数（p < 0.001）、结核病诊断前访问的医疗机构数量（p < 0.001）和私立机构的结核病诊断（p = 0.02）独立预测了诊断前成本的增加。同样，农村居住（p < 0.001）、抗结核治疗期间住院（p < 0.001）、患者延迟天数（p < 0.001）和提供者延迟天数（p < 0.001）预测诊断后费用增加。结论：尽管结核病提供“免费服务”，但结核病患者的就医和治疗费用仍然很高。因此，促进早期求医、分散有效的诊断和人民可及的治疗服务以及引入直接费用报销制度有助于减少患者的经济负担。
Background: Financial burden on tuberculosis (TB) patients results in delayed treatment and poor compliance. We assessed pre- and post-diagnosis costs to TB patients.Methods: A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Direct out-of-pocket, payments, and lost income (indirect cost) were solicited from patients during the first 2 months and at the end of treatment. Thus, we ascertained direct medical, nonmedical, and indirect costs incurred by patients during pre- and post-diagnosis periods. We categorized costs incurred from onset of illness until TB diagnosis as pre-diagnosis and that incurred after diagnosis through treatment completion as post-diagnosis. Pre- and post-diagnosis costs constitute total cost incurred by the patients. We fitted linear regression model to identify predictors of cost.Results: Between onset of illness and anti-TB treatment course, patients incurred a median (inter-quartile range (IQR)) of US$201.48 (136.7-318.94). Of the total cost, the indirect and direct costs respectively constituted 70.6 and 29.4%. TB patients incurred a median (IQR) of US$97.62 (6.43-184.22) and US$93.75 (56.91-141.54) during the pre- and post-diagnosis periods, respectively. Thus, patients incurred 53.6% of the total cost during the pre-diagnosis period. Direct out-of-pocket expenses during the pre- and post-diagnosis periods respectively amount to median (IQR) of US$21.64 (10.23-48.31) and US$35.02 (0-70.04). Patient delay days (p < 0.001), provider delay days (p < 0.001), number of healthcare facilities visited until TB diagnosis (p < 0.001), and TB diagnosis at private facilities (p = 0.02) independently predicted increased pre-diagnosis cost. Similarly, rural residence (p < 0.001), hospitalization during anti-TB treatment (p < 0.001), patient delay days (p < 0.001), and provider delay days (p < 0.001) predicted increased post-diagnosis costs.Conclusion: TB patients incur substantial cost for care seeking and treatment despite "free service" for TB. Therefore, promoting early care seeking, decentralizing efficient diagnosis, and treatment services within reach of peoples, and introducing reimbursement system for direct costs can help minimize financial burden to the patient.