Patient costs for drug-resistant TB diagnosis and pre-treatment evaluation in North India.

IF 1.3 Q4 RESPIRATORY SYSTEM Public Health Action Pub Date : 2024-09-01 DOI:10.5588/pha.24.0018
S Das, R Kumar, A Krishnan, S Kant, A Mohan
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Abstract

Introduction: India's National TB Elimination Programme (NTEP) aims to eliminate TB-related catastrophic expenditure by offering free diagnosis and treatment. However, 3.9% of TB patients have drug-resistant TB (DR-TB) and are facing higher costs.

Objective: To assess DR-TB patients' diagnosis and pre-treatment evaluation costs, catastrophic cost incidence, and its relation to patient characteristics.

Methods: The study included DR-TB patients from three District Drug-Resistant TB Centres in Delhi and Faridabad (October 2021-June 2022). Socio-economic and clinical characteristics and direct medical and non-medical costs from drug susceptibility testing eligibility to the start of DR-TB treatment were collected using patient interviews and records. Indirect costs were calculated via the human capital approach, defining catastrophic costs as expenses over 20% of household annual income. Multivariable regression was used to estimate the effects of patient characteristics on catastrophic costs.

Results: Of 158 patients, 37.3% were aged 19-30 years, and 55.7% were women. Median total cost was USD326.6 (IQR 132.7-666.7), with 48.2% for diagnosis and 66.0% indirect. 32% faced catastrophic costs, with manual labourers at higher risk (adjusted OR 4.4).

Conclusion: Despite free diagnosis and treatment, a significant portion of DR-TB households in India incur catastrophic costs, mainly from indirect expenses, indicating a need for targeted policy and programme interventions.

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印度北部耐药性肺结核诊断和治疗前评估的患者费用。
导言:印度的国家消除结核病计划(NTEP)旨在通过提供免费诊断和治疗,消除与结核病相关的灾难性开支。然而,3.9% 的肺结核病人患有耐药性肺结核(DR-TB),面临着更高的费用:评估 DR-TB 患者的诊断和治疗前评估费用、灾难性费用发生率及其与患者特征的关系:研究对象包括德里和法里达巴德三个地区耐药结核病中心的 DR-TB 患者(2021 年 10 月至 2022 年 6 月)。通过对患者的访谈和记录,收集了从药敏试验合格到开始 DR-TB 治疗期间的社会经济和临床特征以及直接医疗和非医疗成本。间接成本通过人力资本法进行计算,灾难性成本定义为超过家庭年收入 20% 的支出。采用多变量回归法估算了患者特征对灾难性费用的影响:在 158 名患者中,37.3% 年龄在 19-30 岁之间,55.7% 为女性。总费用中位数为 326.6 美元(IQR 为 132.7-666.7 美元),其中 48.2% 用于诊断,66.0% 为间接费用。32%的人面临灾难性费用,体力劳动者的风险更高(调整后 OR 为 4.4):尽管诊断和治疗是免费的,但印度仍有相当一部分 DR-TB 家庭要承担灾难性费用,主要是间接费用,这表明有必要采取有针对性的政策和计划干预措施。
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来源期刊
Public Health Action
Public Health Action RESPIRATORY SYSTEM-
自引率
0.00%
发文量
29
期刊介绍: Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.
期刊最新文献
TB burden and diagnostic challenges at Sandaun Provincial Hospital in West Sepik Province of PNG, 2016-2021. TB-related technical enquiries received at the Research Institute of Tuberculosis, Japan, during COVID-19. Continuous quality improvement in a community-wide TB screening and prevention programme in Papua New Guinea. Effects of extrapulmonary TB on patient quality of life and recurrence. Impact of Truenat on TB diagnosis in Nigeria.
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