The economic burden of households affected by tuberculosis in Brazil: First national survey results, 2019-2021.

Autor: Noia Maciel EL; Laboratory of Epidemiology Federal University of Espírito Santo, UFES, Vitória, ES, Brazil., Negri LDSA; Federal University of Espírito Santo, UFES, Vitória, ES, Brazil., Guidoni LM; Federal University of Espírito Santo, UFES, Vitória, ES, Brazil., Fregona GC; Cassiano Antônio Moraes University Hospital - HUCAM, Vitória, ES, Brazil., Johansen FDC; National TB Programme, Ministry of Health, Brasília, Brazil., Sanchez MN; University of Brasília, UNB, Brasília, DF, Brazil., Moreira ADSR; Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil., Diaz-Quijano FA; University of São Paulo, USP, São Paulo, Brazil., Tonini M; University of Brasília, UNB, Brasília, DF, Brazil., Zandonade E; Federal University of Espírito Santo, ES, Brazil., Ershova J; Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America., Nguhiu P; KEMRI- Wellcome Trust Research Program, Health Economics Research Unit, Nairobi, Kenya., Baena IG; World Health Organization, Global TB Programme, Geneva, Switzerland.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Dec 13; Vol. 18 (12), pp. e0287961. Date of Electronic Publication: 2023 Dec 13 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0287961
Abstrakt: Background: One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a baseline, the magnitude and main drivers of the costs associated with TB disease for patients and their households and to monitor the proportion of households experiencing catastrophic costs in Brazil.
Methods: A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors (<18 years old) were interviewed once about costs, time loss, coping measures, income, household expenses, and asset ownership. Total costs, including indirect costs measured as reported household income change, were expressed as a percentage of annual household income. We used descriptive statistics to analyze the cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs.
Results: We interviewed 603 patients, including 538 (89%) with drug-sensitive (DS) and 65 (11%) with drug-resistant (DR) TB. Of 603 affected households, 48.1% (95%CI: 43-53.2) experienced costs above 20% of their annual household income during their TB episode. The proportion was 44.4% and 78.5% among patients with DS- and DR-TB, respectively. On average, patients incurred costs of US$1573 (95%CI: 1361.8-1785.0) per TB episode, including pre-diagnosis and post-diagnosis expenses. Key cost drivers were post-diagnosis nutritional supplements (US$317.6, 95%CI: 232.7-402.6) followed by medical costs (US$85.5, 95%CI: 54.3-116.5) and costs of travel for clinic visits during treatment (US$79.2, 95%CI: 61.9-96.5). In multivariate analysis, predictors of catastrophic costs included positive HIV status (aOR = 3.0, 95%CI:1.1-8.6) and self-employment (aOR = 2.7, 95%CI:1.1-6.5); high education was a protective factor (aOR = 0.1, 95%CI:0.0-0.9).
Conclusions: Although the services offered to patients with TB are free of charge in the Brazilian public health sector, the availability of free diagnosis and treatment services does not alleviate patients' financial burden related to accessing TB care. The study allowed us to identify the costs incurred by patients and suggest actions to mitigate their suffering. In addition, this study established a baseline for monitoring catastrophic costs and fostering a national policy to reduce the costs to patients for TB care in Brazil.
Competing Interests: JE works for the CDC and participated in the elaboration of the initial proposal and in the writing of the article, but neither she nor the agency had a decision on the analysis of the data and the publication of the research.
(Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)
Databáze: MEDLINE
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