Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa--a systematic review.
Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa--a systematic review.
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DOI：
10.1186/1471-2458-12-980
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发表时间：
2012-11-14
影响因子：
4.5
通讯作者：
Bärnighausen T
中科院分区：
文献类型：
--
作者：
Barter DM;Agboola SO;Murray MB;Bärnighausen T
众所周知，结核病对社会中经济最不利阶层的影响尤为严重。许多研究评估了贫困与结核病之间的关系，但只有少数研究评估了结核病治疗和护理可能给家庭带来的直接经济负担。在撒哈拉以南非洲，受结核病影响的家庭的患者费用尤其沉重，因为那里的贫困程度很高；这些成本包括医疗和非医疗支出的直接成本，以及利用医疗保健的时间成本或工资损失的间接成本。为了全面评估有关结核病患者费用的现有证据，我们对文献进行了系统回顾。检索PubMed、EMBASE、Science Citation Index、Social Science Citation Index、EconLit、Dissertation Abstracts、CINAHL、Sociological Abstracts等数据库，共收录5114篇论文。1994年1月1日至2010年12月31日期间发表的文章，如果包含撒哈拉以南非洲地区肺结核治疗或护理的直接或间接患者费用的定量衡量，则纳入最终审查。从每项研究中提取成本数据，并转换为2010年国际美元（I$）。30篇文章符合所有纳入标准。21项研究报告了直接和间接成本；8项研究只报告了直接成本；一项研究只报告了间接成本。根据成本类型的不同，成本从不足1美元到近600美元不等，从平均年收入收入者平均月收入的一小部分到收入最低的20%人口中收入收入者平均年收入的10倍以上。在本次审查确定的11种结核病患者费用中，私营部门的住院、药物、交通和护理费用最大。撒哈拉以南非洲地区的结核病患者和家庭在利用短期直接观察治疗方案（DOTS）内外的结核病治疗和护理时，往往需要支付高昂的费用。对于许多家庭来说，结核病治疗和护理相关费用被认为是灾难性的，因为在进行本综述中包括的初步研究的国家中，患者的费用通常达到人均收入的10%或更多。我们的研究结果表明，迫切需要降低结核病患者直接和间接成本的政策，以防止因结核病治疗和护理而导致的贫困。
Tuberculosis (TB) is known to disproportionately affect the most economically disadvantaged strata of society. Many studies have assessed the association between poverty and TB, but only a few have assessed the direct financial burden TB treatment and care can place on households. Patient costs can be particularly burdensome for TB-affected households in sub-Saharan Africa where poverty levels are high; these costs include the direct costs of medical and non-medical expenditures and the indirect costs of time utilizing healthcare or lost wages. In order to comprehensively assess the existing evidence on the costs that TB patients incur, we undertook a systematic review of the literature. PubMed, EMBASE, Science Citation Index, Social Science Citation Index, EconLit, Dissertation Abstracts, CINAHL, and Sociological Abstracts databases were searched, and 5,114 articles were identified. Articles were included in the final review if they contained a quantitative measure of direct or indirect patient costs for treatment or care for pulmonary TB in sub-Saharan Africa and were published from January 1, 1994 to Dec 31, 2010. Cost data were extracted from each study and converted to 2010 international dollars (I$). Thirty articles met all of the inclusion criteria. Twenty-one studies reported both direct and indirect costs; eight studies reported only direct costs; and one study reported only indirect costs. Depending on type of costs, costs varied from less than I$1 to almost I$600 or from a small fraction of mean monthly income for average annual income earners to over 10 times average annual income for income earners in the income-poorest 20% of the population. Out of the eleven types of TB patient costs identified in this review, the costs for hospitalization, medication, transportation, and care in the private sector were largest. TB patients and households in sub-Saharan Africa often incurred high costs when utilizing TB treatment and care, both within and outside of Directly Observed Therapy Short-course (DOTS) programs. For many households, TB treatment and care-related costs were considered to be catastrophic because the patient costs incurred commonly amounted to 10% or more of per capita incomes in the countries where the primary studies included in this review were conducted. Our results suggest that policies to decrease direct and indirect TB patient costs are urgently needed to prevent poverty due to TB treatment and care for those affected by the disease.
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影响因子：
3.3
作者：
Castillo-Riquelme, Marianela;McIntyre, Diane;Barnes, Karen
通讯作者：
Barnes, Karen
影响因子：
3.3
作者：
Cambanis, A;Yassin, MA;Cuevas, LE
通讯作者：
Cuevas, LE
影响因子：
3.1
作者：
Bahadori, Katayoun;Doyle-Waters, Mary M;FitzGerald, J Mark
通讯作者：
FitzGerald, J Mark
影响因子：
3.5
作者：
Chang, B;Wu, AW;Diette, GB
通讯作者：
Diette, GB
影响因子：
2.2
作者：
Chard, Sarah E.
通讯作者：
Chard, Sarah E.