P Sinha1, M Carwile2, A Bhargava3,4,5, C Cintron1, C Acuna-Villaorduna1, S Lakshminarayan6, A F Liu7, N Kulatilaka8, L Locks9, N S Hochberg1,10. 1. Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA. 2. Department of Global Health, Boston University School of Public Health, MA, USA. 3. Department of Medicine, Yenepoya Medical College, Mangalore, India. 4. Department of Medicine, McGill University, Montreal, Quebec, Canada. 5. Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, India. 6. Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India. 7. Department of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA. 8. Susilo Institute for Ethics in a Global Economy, Boston University Questrom School of Business, Boston, MA, USA. 9. Department of Health Sciences, Sargent College, Boston University College of Health & Rehabilitation Sciences, Boston, MA, USA. 10. Department of Epidemiology, Boston University School of Public Health, MA, USA.
Abstract
SETTING: India's National Tuberculosis Elimination Programme (NTEP) covers diagnostic and therapeutic costs of TB treatment. However, persons living with TB (PLWTB) continue to experience financial distress due to direct costs (payment for testing, treatment, travel, hospitalization, and nutritional supplements) and indirect costs (lost wages, loan interest, and cost of domestic helpers). OBJECTIVE: To analyze the magnitude and pattern of TB-related costs from the perspective of Indian PLWTB. DESIGN: We identified relevant articles using key search terms ('tuberculosis,' 'India,' 'cost,' 'expenditures,' 'financing,' 'catastrophic' and 'out of pocket') and calculated variance-weighted mean costs. RESULTS: Indian patients incur substantial direct costs (mean: US$46.8). Mean indirect costs (US$666.6) constitute 93.4% of the net costs. Mean direct costs before diagnosis can be up to four-fold that of costs during treatment. Treatment in the private sector can result in costs up to six-fold higher than in government facilities. As many as one in three PLWTB in India experience catastrophic costs. CONCLUSION: PLWTB in India face high direct and indirect costs. Priority interventions to realize India's goal of eliminating catastrophic costs from TB include decreasing diagnostic delays through active case finding, reducing the need for travel, improving awareness and perception of NTEP services, and ensuring sufficient reimbursement for inpatient TB care.
SETTING: India's National Tuberculosis Elimination Programme (NTEP) covers diagnostic and therapeutic costs of TB treatment. However, persons living with TB (PLWTB) continue to experience financial distress due to direct costs (payment for testing, treatment, travel, hospitalization, and nutritional supplements) and indirect costs (lost wages, loan interest, and cost of domestic helpers). OBJECTIVE: To analyze the magnitude and pattern of TB-related costs from the perspective of Indian PLWTB. DESIGN: We identified relevant articles using key search terms ('tuberculosis,' 'India,' 'cost,' 'expenditures,' 'financing,' 'catastrophic' and 'out of pocket') and calculated variance-weighted mean costs. RESULTS: Indian patients incur substantial direct costs (mean: US$46.8). Mean indirect costs (US$666.6) constitute 93.4% of the net costs. Mean direct costs before diagnosis can be up to four-fold that of costs during treatment. Treatment in the private sector can result in costs up to six-fold higher than in government facilities. As many as one in three PLWTB in India experience catastrophic costs. CONCLUSION: PLWTB in India face high direct and indirect costs. Priority interventions to realize India's goal of eliminating catastrophic costs from TB include decreasing diagnostic delays through active case finding, reducing the need for travel, improving awareness and perception of NTEP services, and ensuring sufficient reimbursement for inpatient TB care.
Authors: R Rajeswari; R Balasubramanian; M Muniyandi; S Geetharamani; X Thresa; P Venkatesan Journal: Int J Tuberc Lung Dis Date: 1999-10 Impact factor: 2.373
Authors: Nicolas A Menzies; Gabriela B Gomez; Fiammetta Bozzani; Susmita Chatterjee; Nicola Foster; Ines Garcia Baena; Yoko V Laurence; Sun Qiang; Andrew Siroka; Sedona Sweeney; Stéphane Verguet; Nimalan Arinaminpathy; Andrew S Azman; Eran Bendavid; Stewart T Chang; Ted Cohen; Justin T Denholm; David W Dowdy; Philip A Eckhoff; Jeremy D Goldhaber-Fiebert; Andreas Handel; Grace H Huynh; Marek Lalli; Hsien-Ho Lin; Sandip Mandal; Emma S McBryde; Surabhi Pandey; Joshua A Salomon; Sze-Chuan Suen; Tom Sumner; James M Trauer; Bradley G Wagner; Christopher C Whalen; Chieh-Yin Wu; Delia Boccia; Vineet K Chadha; Salome Charalambous; Daniel P Chin; Gavin Churchyard; Colleen Daniels; Puneet Dewan; Lucica Ditiu; Jeffrey W Eaton; Alison D Grant; Piotr Hippner; Mehran Hosseini; David Mametja; Carel Pretorius; Yogan Pillay; Kiran Rade; Suvanand Sahu; Lixia Wang; Rein M G J Houben; Michael E Kimerling; Richard G White; Anna Vassall Journal: Lancet Glob Health Date: 2016-10-06 Impact factor: 26.763
Authors: Juliet Addo; Dave Pearce; Marilyn Metcalf; Courtney Lundquist; Gillian Thomas; David Barros-Aguirre; Gavin C K W Koh; Mike Strange Journal: BMC Public Health Date: 2022-09-10 Impact factor: 4.135