Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Assessment of Household Catastrophic Total Cost of Tuberculosis and Its Determinants in Cairo: Prospective Cohort Study

  • Ellaban, Manar M. (Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University) ;
  • Basyoni, Nashwa I. (Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University) ;
  • Boulos, Dina N.K. (Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University) ;
  • Rady, Mervat (Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University) ;
  • Gadallah, Mohsen (Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University)
  • Received : 2021.02.16
  • Accepted : 2021.09.01
  • Published : 2022.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: One goal of the End tuberculosis (TB) Strategy is to see no TB-affected households experiencing catastrophic costs. Therefore, it is crucial for TB-elimination programs to identify catastrophic costs and their main drivers in order to establish appropriate health and social measures. This study aimed to measure the percent of catastrophic costs experienced by Egyptian TB patients and to identify its determinants. Methods: We conducted a prospective cohort study with 151 Egyptian TB patients recruited from two chest dispensaries from the Cairo governate from May 2019 to May 2020. We used a validated World Health Organization TB patient-cost tool to collect data on patients' demographic information, household income, and direct and indirect expense of seeking TB treatment. We considered catastrophic TB costs to be total costs exceeding 20% of the household's annual income. Results: Of the patients, 33% experienced catastrophic costs. The highest proportion of the total came in the pre-treatment stage. Being the main breadwinner, experiencing job loss, selling property, and the occurrence of early coronavirus disease 2019 lockdown were independent determinants of the incidence of catastrophic costs. Borrowing money and selling property were the most-often reported coping strategies adopted. Conclusion: Despite the availability of free TB care under the Egyptian National TB Program, nearly a third of the TB patients incurred catastrophic costs. Job loss and being the main breadwinner were among the significant predictors of catastrophic costs. Social protection mechanisms, including cash assistance and insurance coverage, are necessary to achieve the goal of the End TB Strategy.

Keywords

Acknowledgement

We thank the NTP team for enabling this research and providing support. We are also grateful to all of the participating patients for their cooperation.

References

  1. WHO Regional Office for the Eastern Mediterranean. Stop tuberculosis [Internet]. Geneva: World Health Organization; 2018 [cited 2020 May 30]. Available from: http://www.emro.who.int/entity/tuberculosis/about-stop-tb.html.
  2. Asres A, Jerene D, Deressa W. Pre- and post-diagnosis costs of tuberculosis to patients on Directly Observed Treatment Short course in districts of southwestern Ethiopia: a longitudinal study. J Health Popul Nutr 2018;37:15. https://doi.org/10.1186/s41043-018-0146-0
  3. World Health Organization, Africa. Tuberculosis (TB) [Internet]. Geneva: World Health Organization; 2017 [cited 2020 May 30]. Available from: https://www.afro.who.int/health-topics/tuberculosis-tb.
  4. World Health Organization. Tuberculosis patient cost surveys: a hand book [Internet]. Geneva: World Health Organization; 2017 [cited 2019 Apr 20]. Available from: http://apps.who.int/bookorders.
  5. Laokri S, Dramaix-Wilmet M, Kassa F, Anagonou S, Dujardin B. Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities. Trop Med Int Health 2014;19:1249-58. https://doi.org/10.1111/tmi.12365
  6. Chowdhury AS. Estimating costs of illness and catastrophic health expenditure of tuberculosis patients in BRAC DOTS program. Research monograph series 77. The Author; 2018.
  7. Stracker N, Hanrahan C, Mmolawa L, Nonyane B, Tampi R, Tucker A, et al. Risk factors for catastrophic costs associated with tuberculosis in rural South Africa. Int J Tuberc Lung Dis 2019;23:756-63. https://doi.org/10.5588/ijtld.18.0519
  8. Mailu E. The first national tuberculosis patient cost survey in Kenya, 2017 [Internet]. Nairobi: Republic of Kenya, Ministry of Health; 2018 [cited 2020 May 30]. Available from: http://kelinkenya.org/wp-content/uploads/2018/07/TB-Patient-Cost-Survey-Dissemination-30-06-2018.pdf.
  9. Viney K, Islam T, Hoa NB, Morishita F, Lonnroth K. The financial burden of tuberculosis for patients in the Western-Pacific region. Trop Med Infect Dis 2019;4:94. https://doi.org/10.3390/tropicalmed4020094
  10. Prasanna T, Jeyashree K, Chinnakali P, Bahurupi Y, Vasudevan K, Das M. Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India. Glob Health Action 2018;11:1477493. https://doi.org/10.1080/16549716.2018.1477493
  11. World Health Organization. Tuberculosis profile, Egypt, 2018 [Internet]. Geneva: World Health Organization; 2018 [cited 2020 May 30]. Available from: https://www.who.int/gho/countries/egy/country_profiles/en/.
  12. Ministry of Health and Population. National Tuberculosis Control Program: Egypt [Internet]. Cairo: Ministry of Health and Population; 2017 [cited 2020 May 30]. Available from: http://www.ccs.gov.eg/ntp/NTP_introd.htm.
  13. Fuady A, Houweling TAJ, Mansyur M, Richardus JH. Catastrophic total costs in tuberculosis-affected households and their determinants since Indonesia's implementation of universal health coverage. Infect Dis Poverty 2018;7:3. https://doi.org/10.1186/s40249-017-0382-3
  14. World Health Organization. WHO Global TB Programme. Protocol for survey to determine direct and indirect costs due to TB and to estimate proportion of TB-affected households experiencing catastrophic costs due to TB Field testing 2015 (Issue November) [Internet]. Geneva: World Health Organization; 2015 [cited 2020 May 30]. Available from: https://www.who.int/tb/advisory_bodies/impact_measurement_taskforce/meetings/tf6_background. _5a_patient_cost_surveys_protocol.pdf?ua=1.
  15. Tanimura T, Jaramillo E, Weil D, Raviglione M, Lonnroth K. Financial burden for tuberculosis patients in low- and middle-income countries: a systematic review. Eur Respir J 2014;43:1763-75. https://doi.org/10.1183/09031936.00193413
  16. Wingfield T, Boccia D, Tovar M, Gavino A, Zevallos K, Montoya R, et al. Defining catastrophic costs and comparing their importance for adverse tuberculosis outcome with multidrug resistance: a prospective cohort study, Peru. PLoS Med 2014;11:e1001675. https://doi.org/10.1371/journal.pmed.1001675
  17. Duan W, Zhang W, Wu C, Wang Q, Yu Y, Lin H, et al. Extent and determinants of catastrophic health expenditure for tuberculosis care in Chongqing municipality, China: a cross-sectional study. BMJ Open 2019;9:e026638. https://doi.org/10.1136/bmjopen-2018-026638
  18. Mullerpattan JB, Udwadia ZZ, Banka RA, Ganatra SR, Udwadia ZF. Catastrophic costs of treating drug resistant TB patients in a tertiary care hospital in India. Indian J Tuberc 2019;66:87-91. https://doi.org/10.1016/j.ijtb.2018.04.011
  19. Mudzengi D, Sweeney S, Hippner P, Kufa T, Fielding K, Grant AD, et al. The patient costs of care for those with TB and HIV: a cross-sectional study from South Africa. Health Policy Plan 2017;32:iv48-56. https://doi.org/10.1093/heapol/czw183
  20. Tomeny EM, Mendoza VL, Marcelo DB, Barrameda AJD, Langley I, Abong JM, et al. Patient-cost survey for tuberculosis in the context of patient-pathway modelling. Int J Tuberc Lung Dis 2020;24:420-7. https://doi.org/10.5588/ijtld.19.0206
  21. Ministry of Health (Uganda). Direct and Indirect costs due to tuberculosis and proportion of tuberculosis-affected households experiencing catastrophic costs due to TB in Uganda Febrauray 2019 [Internet]. Kampala: Ministry of Health; 2019 [cited 2020 May 30]. Available from: https://www.health.go.ug/cause/direct-and-indirect-costs-due-to-tuberculosis-and-proportion-of-tuberculosis-affected-households-experiencingcatastrophic-costs-due-to-tb-in-uganda-febrauary-2019/.
  22. Foster N, Vassall A, Cleary S, Cunnama L, Churchyard G, Sinanovic E. The economic burden of TB diagnosis and treatment in South Africa. Soc Sci Med 2015;130:42-50. https://doi.org/10.1016/j.socscimed.2015.01.046
  23. Sarin R, Vohra V, Singla N, Thomas B, Krishnan R, Muniyandi M. Identifying costs contributing to catastrophic expenditure among TB patients registered under RNTCP in Delhi metro city in India. Indian J Tuberc 2019;66:150-7. https://doi.org/10.1016/j.ijtb.2018.10.009
  24. Laokri S, Weil O, Drabo KM, Dembele SM, Kafando B, Dujardin B. Removal of user fees no guarantee of universal health coverage: observations from Burkina Faso. Bull World Health Organ 2013;91:277-82. https://doi.org/10.2471/BLT.12.110015
  25. UNAIDS. Country Factsheets. HIV and AIDS estimate: Egypt [Internet]. Geneva: UNAIDS; 2019 [cited 2020 May 30]. Available from: https://www.unaids.org/en/regionscountries/countries/egypt.