The socioeconomic impact of multidrug-resistant TB on patients: results from Ethiopia, Indonesia and Kazakhstan
Abstract
Background
One of the main goals of
the post-2015 global tuberculosis (TB) strategy is that no
families affected by TB face catastrophic costs. We revised an
existing TB patient cost measurement tool to specifically also
measure multidrug-resistant TB (MDR-TB) patients’ costs
and applied it in Ethiopia, Indonesia and Kazakhstan.
Methods
Through structured
interviews with TB and MDR-TB patients in different stages of
treatment, we collected data on the direct (out of pocket) and
indirect (loss of income) costs of patients and their families
related to the diagnosis and treatment of TB and MDR-TB. Direct
costs included costs for hospitalization, follow-up tests,
transport costs for health care visits, and food supplements.
Calculation of indirect costs was based on time needed for
diagnosis and treatment. Costs were extrapolated over the
patient’s total treatment phase.
Results
In total 406 MDR-TB patients
and 197 other TB patients were included in the survey: 169
MDR-TB patients and 25 other TB patients in Ethiopia; 143 MDR-TB
patients and 118 TB patients in Indonesia; and 94 MDR-TB
patients and 54 other TB patients in Kazakhstan. Total costs for
diagnosis and current treatment episode for TB patients were
estimated to be USD 260 in Ethiopia, USD 169 in Indonesia, and
USD 929 in Kazakhstan, compared to USD 1838, USD 2342, and USD
3125 for MDR-TB patients, respectively. These costs represented
0.82–4.6 months of pre-treatment household income for TB
patients and 9.3–24.9 months for MDR-TB patients.
Importantly, 38–92 % reported income loss and 26–76
% of TB patients lost their jobs due to (MDR) TB illness,
further aggravating the financial burden.
Conclusions
The financial burden of
MDR-TB is alarming, although all TB patients experienced
substantial socioeconomic impact of the disease. If the patient
is the breadwinner of the family, the combination of lost income
and extra costs is generally catastrophic. Therefore, it should
be a priority of the government to relieve the financial burden
based on the cost mitigation options identified.
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Source: BMC Infectious Diseases
