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Patient medical costs for tuberculosis treatment and impact on adherence in China: a systematic review

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Long, Qian, Smith, Helen ORCID: https://orcid.org/0000-0002-6252-3793, Zhang, Tuohong, Tang, Shenglan and Garner, Paul ORCID: https://orcid.org/0000-0002-0607-6941 (2011) 'Patient medical costs for tuberculosis treatment and impact on adherence in China: a systematic review'. BMC Public Health, Vol 11, :393.

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Abstract

Background
Charging for tuberculosis (TB) treatment could reduce completion rates, particularly in the poor. We identified and synthesised studies that measure costs of TB treatment, estimates of adherence and the potential impact of charging on treatment completion in China.

Methods
Inclusion criteria were primary research studies, including surveys and studies using qualitative methods, conducted in mainland China. We searched MEDLINE, PUBMED, EMBASE, Science Direct, HEED, CNKI to June 2010; and web pages of relevant Chinese and international organisations. Cost estimates were extracted, transformed, and expressed in absolute values and as a percentage of household income.

Results
Low income patients, defined at household or district level, pay a total of US$ 149 to 724 (RMB 1241 to 5228) for medical costs for a treatment course; as a percentage of annual household income, estimates range from 42% to 119%. One national survey showed 73% of TB patients at the time of the survey had interrupted or suspended treatment, and estimates from 9 smaller more recent studies showed that the proportion of patients at the time of the survey who had run out of drugs or were not taking them ranged from 3 to 25%. Synthesis of surveys and qualitative research indicate that cost is the most cited reason for default.

Conclusions
Despite a policy of free drug treatment for TB in China, health services charge all income groups, and costs are high. Adherence measured in cross sectional surveys is often low, and the cumulative failure to adhere is likely to be much higher. These findings may be relevant to those concerned with the development and spread of multi-drug resistant TB. New strategies need to take this into account and ensure patient adherence.

Item Type: Article
Additional Information: The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2458/11/393
Uncontrolled Keywords: tuberculosis; China; Systematic Review
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
Digital Object Identifer (DOI): https://doi.org/10.1186/1471-2458-11-393
Depositing User: q Moody
Date Deposited: 15 Aug 2011 14:59
Last Modified: 22 Feb 2018 15:52
URI: https://archive.lstmed.ac.uk/id/eprint/2284

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