MDR-TB treatment costs 235% one's income: Study

A new study on the health economics of multi-drug TB treatment in Mumbai has computed that an individual could spend two years of his total income to get rid of the virulent TB bacteria. One particular family that was part of the study spent Rs 25 lakh over a two-year period.

The TB bacillus has evolved in the last decade to render many anti-TB medicines ineffective; higher antibiotics that are expensive are now needed to treat the drug-resistant forms of TB.

Dr Zarir Udwadia, the study's main author who jolted Indian health officials in 2011 by reporting the presence of totally drug-resistant TB cases in Mumbai, calculated that TB treatment in the private sector could be as high as "235% of individual income and 53% of annual family income". The study, presented at the recent European Respiratory Society's meeting in London, looked at every TB treatment-related expense of 50 patients under treatment at Hinduja Hospital, Mahim, for either multi- or extremely drug-resistant TB.

"The mean treatment cost was Rs 4.8 lakh, but it ranged from Rs 1.3 lakh to Rs 25 lakh over two years," said the paper's co-author Dr Jai Mullerpattan. The cost ran into tens of lakhs for some patients who needed specialized interventions like brain surgery as well as extended ICU stay, he added.

But it was on drugs that patients spent the most — as much as 37% of their total treatment cost. "Many took loans. Some sold jewellery and property to fund their medication. TB is a disease of poverty but also causes poverty,'' Udwadia told TOI.

Another chunk of the expenses come from hospitalization, doctors' fees, taxis, blood tests and nutritional supplements needed to balance the side-effects of TB medication. Rina, a schoolteacher, shells out Rs 6,000 per month on her 18-year-old daughter's anti-tuberculosis medicines. Some months, her expenses would double due to the tests and nutritional supplements.

Doctors say the middle classes face a peculiar problem with TB treatment. "Many patients who cannot afford expenses take medicines from the government sector, but the middle classes go to the private sector," said Dr Yatin Dholakia, secretary and technical adviser of the Maharashtra State Anti-TB Association. "Even if they need a short hospitalization, they have to go to big hospitals as nursing homes won't take an MDR-TB patient. This adds to their treatment cost.''

Take the case of 26-year-old Kirti, who had just graduated when he was first diagnosed with TB in 2011. Over the next five years, the disease emerged and re-emerged in drug-resistant forms. "We spent over Rs 5 lakh in the 30 months that he was treated for MDR-TB," said Kirti's sister. This included medicines, several hospitalizations and long-drawn psychiatric treatment. Most patients require concurrent treatment for the side-effects of TB medicines on their skin, hearing, mind, etc.

The solution, according to Udwadia, lies in reducing costs of drugs. Erica Lessem of the international NGO Treatment Action Group (TB/HIV project) said: "Dr Udwadia's study clearly shows that TB causes poverty, and we know poverty also, in turn, leads to more TB. If India is serious about development, it must get serious about providing free quality TB services."

The fact that many people with TB turn to the private sector is a clear indication that India's public TB programme is not meeting people's needs. "That the largest portion of the immense financial burden patients and their families bear is due to drug costs is a crime. Providing free, quality TB care to all is a cornerstone of any good TB programme. India is failing to do this, so how will it ever achieve TB-free India?" Lessem asked.

Source: The Times of India