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Patient-cost survey for tuberculosis in the context of patient-pathway modelling.

Tomeny, Ewan ORCID:, Mendoza, Victor L, Marcelo, Danaida B, Barrameda, Armen Jheannie D, Langley, Ivor ORCID:, Abong, Jovilia M, Dalay, Victoria B, Yu, Charles Y and Squire, Bertie ORCID: (2020) 'Patient-cost survey for tuberculosis in the context of patient-pathway modelling.'. International Journal of Tuberculosis and Lung Disease, Vol 24, Issue 4, pp. 420-427.

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ETTING: Eight tuberculosis treatment sites in Cavite Province, the Philippines, including two sites specialising in management of multidrug-resistant tuberculosis (MDR-TB).OBJECTIVE: To evaluate costs incurred by TB patients and to determine the proportion of households that faced catastrophic costs, then to consider cost survey responses alongside results of detailed patient-pathway modelling.DESIGN: Clustered cross-sectional survey using a field testing version of the WHO TB patient-costing tool and protocol; face-to-face interviews with 194 patients conducted in May-August 2016. Costs included direct-medical, direct non-medical and indirect costs using the human capital approach. Patients were deemed to incur catastrophic expenditure if TB-related costs exceeded 20% of annual household income. Patient pathways were modelled following multiple health staff interviews.RESULTS: Estimated mean cost incurred by patients with drug-susceptible TB was US$321 vs. $2356 for MDR-TB patients. Catastrophic costs were suffered by 28% of drug-susceptible and 80% of MDR-TB patients, with lost income being the largest contributor. Patient-pathway modelling suggested most patients had under-reported health visits.CONCLUSION: Survey results indicate that patient costs are large for all patients in Cavite, particularly for MDR-TB patients. Patient-pathway modelling suggests these costs are an underestimate due to poor recollection of health visits, suggesting that the WHO instrument and protocol could be improved to better capture the diagnostic journey.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 74 Medical economics. Health care costs
QS Anatomy > QS 4 General works. Classify here works on regional anatomy
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
Depositing User: Joy Gilroy
Date Deposited: 23 Apr 2020 14:46
Last Modified: 23 Apr 2020 14:46


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