L Ramma1, H Cox2, L Wilkinson3, N Foster1, L Cunnama1, A Vassall4, E Sinanovic1. 1. Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. 2. Division of Medical Microbiology, and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. 3. Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa. 4. London School of Hygiene & Tropical Medicine, London, UK.
Abstract
SETTING: South Africa is one of the world's 22 high tuberculosis (TB) burden countries, with the second highest number of notified rifampicin-resistant TB (R(R)-TB) and multidrug-resistant TB (MDR-TB) cases. OBJECTIVE: To estimate patient costs associated with the diagnosis and treatment of R(R)-TB/MDR-TB in South Africa. DESIGN: Patients diagnosed with R(R)-TB/MDR-TB and accessing care at government health care facilities were surveyed using a structured questionnaire. Direct and indirect costs associated with accessing R(R)-TB/MDR-TB care were estimated at different treatment durations for each patient. RESULTS: A total of 134 patients were surveyed: 84 in the intensive phase and 50 in the continuation phase of treatment, 82 in-patients and 52 out-patients. The mean monthly patient costs associated with the diagnosis and treatment of R(R)-TB/MDR-TB were higher during the intensive phase than the continuation phase (US$235 vs. US$188) and among in-patients than among out-patients (US$269 vs. US$122). Patients in the continuation phase and those accessing care as out-patients reported higher out-of-pocket costs than other patients. Most patients did not access social protection for costs associated with R(R)-TB/MDR-TB illness. CONCLUSION: Despite free health care, patients bear high costs when accessing diagnosis and treatment services for R(R)-TB/MDR-TB; appropriate social protection mechanisms should be provided to assist them in coping with these costs.
SETTING: South Africa is one of the world's 22 high tuberculosis (TB) burden countries, with the second highest number of notified rifampicin-resistant TB (R(R)-TB) and multidrug-resistant TB (MDR-TB) cases. OBJECTIVE: To estimate patient costs associated with the diagnosis and treatment of R(R)-TB/MDR-TB in South Africa. DESIGN:Patients diagnosed with R(R)-TB/MDR-TB and accessing care at government health care facilities were surveyed using a structured questionnaire. Direct and indirect costs associated with accessing R(R)-TB/MDR-TB care were estimated at different treatment durations for each patient. RESULTS: A total of 134 patients were surveyed: 84 in the intensive phase and 50 in the continuation phase of treatment, 82 in-patients and 52 out-patients. The mean monthly patient costs associated with the diagnosis and treatment of R(R)-TB/MDR-TB were higher during the intensive phase than the continuation phase (US$235 vs. US$188) and among in-patients than among out-patients (US$269 vs. US$122). Patients in the continuation phase and those accessing care as out-patients reported higher out-of-pocket costs than other patients. Most patients did not access social protection for costs associated with R(R)-TB/MDR-TB illness. CONCLUSION: Despite free health care, patients bear high costs when accessing diagnosis and treatment services for R(R)-TB/MDR-TB; appropriate social protection mechanisms should be provided to assist them in coping with these costs.
Authors: L Mitrani; L Dickson-Hall; S Le Roux; J Hill; M Loveday; A D Grant; K Kielmann; K Mlisana; M Moshabela; M P Nicol; J Black; H Cox Journal: Public Health Action Date: 2021-09-21
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Authors: Stéphane Verguet; Carlos Riumallo-Herl; Gabriela B Gomez; Nicolas A Menzies; Rein M G J Houben; Tom Sumner; Marek Lalli; Richard G White; Joshua A Salomon; Ted Cohen; Nicola Foster; Susmita Chatterjee; Sedona Sweeney; Inés Garcia Baena; Knut Lönnroth; Diana E Weil; Anna Vassall Journal: Lancet Glob Health Date: 2017-11 Impact factor: 26.763
Authors: Jason J Madan; Laura Rosu; Mamo Girma Tefera; Craig van Rensburg; Denise Evans; Ivor Langley; Ewan M Tomeny; Andrew Nunn; Patrick Pj Phillips; I D Rusen; S Bertel Squire Journal: Bull World Health Organ Date: 2020-02-25 Impact factor: 9.408