How affordable is TB care? Findings from a nationwide TB patient cost survey in Ghana
How affordable is TB care? Findings from a nationwide TB patient cost survey in Ghana
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DOI：
10.1111/tmi.13085
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发表时间：
2018-08-01
影响因子：
3.3
通讯作者：
Borghi, Josephine
中科院分区：
文献类型：
--
作者：
Pedrazzoli, Debora;Siroka, Andrew;Borghi, Josephine
结核病（TB）是一种常见于穷人的疾病。尽管结核病诊断和治疗通常是免费提供的，但结核病患者仍然面临巨大的费用，特别是在多药耐药性（MDR）的情况下。《终结结核病战略》呼吁到2025年，使受结核病影响的家庭因结核病而承担灾难性的成本为零。本文根据结核病耐多药状况，分析了结核病患者家庭在就医和治疗过程中的费用水平和构成，并采用灾难性和惩罚性措施评估了结核病治疗的可负担性;并介绍了应对策略TB受影响的家庭支付TB Care.MethodsA结核病患者在公共卫生设施在全国范围内具有代表性的调查在整个Ghana.ResultsWe招募了691例（66 MDR）。治疗期间，非MDR TB的中位支出为429.6美元，MDR患者为659.0美元（P值= 0.001）。灾难性的费用影响了64.1%的患者。MDR患者比DS患者被推到灾难性支付的门槛之上。与结核病诊断前相比，支付结核病护理费用导致调查样本中生活在贫困线以下的家庭比例显著增加。超过一半的患者进行应对strategies.ConclusionTB患者在加纳产生大量的费用，尽管免费的诊断和治疗。非MDR和MDR患者的灾难性成本和应对策略的高比率表明，迫切需要新的政策来确保结核病患者实际上负担得起结核病治疗。
ObjectivesTuberculosis (TB) is known as a disease of the poor. Despite TB diagnosis and care usually being offered for free, TB patients can still face substantial costs, especially in the context of multi-drug resistance (MDR). The End TB Strategy calls for zero TB-affected families incurring catastrophic' costs due to TB by 2025. This paper examines, by MDR status, the level and composition of costs incurred by TB-affected households during care seeking and treatment; assesses the affordability of TB care using catastrophic and impoverishment measures; and describes coping strategies used by TB-affected households to pay for TB care.MethodsA nationally representative survey of TB patients at public health facilities across Ghana.ResultsWe enrolled 691 patients (66 MDR). The median expenditure for non-MDR TB was US$429.6 during treatment, vs. US$659.0 for MDR patients (P-value = 0.001). Catastrophic costs affected 64.1% of patients. MDR patients were pushed significantly further over the threshold for catastrophic payments than DS patients. Payments for TB care led to a significant increase in the proportion of households in the study sample that live below the poverty line at the time of survey compared to pre-TB diagnosis. Over half of patients undertook coping strategies.ConclusionTB patients in Ghana incur substantial costs, despite free diagnosis and treatment. High rates of catastrophic costs and coping strategies in both non-MDR and MDR patients show that new policies are urgently needed to ensure TB care is actually affordable for TB patients.