TITLE:
Is Tuberculosis Treatment Truly Free? A Study to Identify Key Factors Contributing to the Catastrophic Cost of TB Care in Pakistan
AUTHORS:
Aamer Ikram, Amna Ali, Sana Habib Abbasi, Nosheen Ashraf, Sidra Wali, Mohammad Salman, Mumtaz A. Khan, Naveed Syed, Jamil A. Ansari
KEYWORDS:
Tuberculosis, Financial Deprivation, Catastrophic Cost
JOURNAL NAME:
Journal of Tuberculosis Research,
Vol.8 No.4,
November
5,
2020
ABSTRACT:
Background: The interplay between financial deprivation and tuberculosis (TB) is
considered one of the vital socio-economic determinants of disease. This is the
first study of its kind to be carried in Pakistan, which aims to identify
leading factors contributing towards catastrophic costs of TB diagnosis and
management in order to help policy makers. Methodology: From four
tertiary care hospitals (TCH) in Islamabad and Rawalpindi, 400 TB patients were
interviewed through a cross-sectional survey. The patient’s pre and post-TB income and direct and
indirect costs for treatment were analysed following WHO recommendations.
Multivariable logistic regression model was used to identify the determinants
of catastrophic total cost. Results: For TB
management expenditures, the median (interquartile range) of total costs by
households was Rs. 58,175
Rs (32,050 - 97,500).
At 20% threshold, 67% of TB patient’s households were affected by catastrophic
costs. The determinants of the catastrophic total cost were as follows:
patient/guardian employed (adjusted odds ratio [aOR] = 3.428, 95% confidence
interval [CI]: 1.900 - 6.186),
patient/guardian the only breadwinner (aOR = 1.751, 95% CI: 1.011 - 3.032),
follow-up visits at current health facility (aOR = 1.352, 95% CI: 1.223 - 1.494),
job loss (aOR = 3.381, 95% CI: 1.512 - 7.561), and unpaid sick
leaves (aOR = 2.862, 95% CI: 1.249 - 6.558). Conclusion: The
financial deprivation experienced by patients of low socio-economic status
increases as TB treatment proceeds. This negatively impacts the treatment
adherence, resulting in poor treatment outcomes due to income and job loss.
Outcomes are exacerbated if the family has single breadwinner and treatment
requires follow-up visits.