Background: The World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal.
Methods: The study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income. The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis.
Results: Ninety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32, P = 0.001; direct non-medical: USD 3 vs USD 10, P = 0.004; indirect, time loss: USD 4 vs USD 13, P < 0.001). The cost of the pre-treatment and intensive phases combined was also lower for direct medical (USD 15 vs USD 34, P = 0.002) and non-medical (USD 30 vs USD 54, P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant.
Conclusions: ACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.
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http://dx.doi.org/10.1186/s40249-019-0603-z | DOI Listing |
East Mediterr Health J
December 2024
Department of Economics, Health Economics and Health Policy Research and Applciation Center, Hacettepe University, Ankara, Türkiye.
Background: Understanding the financial burden of smoking on households is crucial for developing effective strategies and policies to reduce smoking and mitigate its impact on household health.
Aim: To investigate the relationship between smoking and catastrophic health expenditure in Türkiye.
Methods: This cross-sectional study used microdata from household budget surveys conducted by the Turkish Statistical Institute in 2015 and 2019.
Am J Surg
December 2024
Department of Surgery, Northwestern University Feinberg School of Medicine, USA.
Background: Nearly a billion people worldwide risk Financial Catastrophe (FC) due to Out-of-Pocket (OOP) health expenditures. With Low-and-Middle-Income Countries (LMICs) disproportionately impacted, and the global burden of colorectal cancer (CRC) expected to increase 60 % by 2030, Nigeria is of interest. This study aims to evaluate the cost of treating CRC at Nigeria's first private cancer center.
View Article and Find Full Text PDFFront Public Health
December 2024
Department of Biostatistics, Amrita Institute of Medical Sciences Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
Background: Multimorbidity, the coexistence of two or more chronic conditions in an individual, has emerged as a significant public health challenge with profound economic implications, exerting substantial strain on healthcare systems and economies worldwide. This study aimed to estimate the prevalence of non-communicable diseases (NCD) related multimorbidity, catastrophic health expenditure (CHE), and associated factors among adults aged ≥40 years in Ernakulam district.
Methods: A community-based cross-sectional study was conducted among 420 individuals aged ≥40 years using population probability sampling.
Int J Equity Health
December 2024
International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK.
Background: People with disabilities often incur higher costs for healthcare, due to higher needs, greater indirect costs, and the need for services not offered by the public system. Yet, people with disabilities are more likely to experience poverty and so have reduced capacity to pay. Health insurance is an important social protection strategy to meet healthcare needs and avoid catastrophic expenditures for this group.
View Article and Find Full Text PDFLancet Gastroenterol Hepatol
December 2024
The Francis Crick Institute, London NW1 1AT, UK; Division of Infection and Immunity, University College London, London, UK; Bloomsbury Clinic, Central and North West London NHS Foundation Trust, London, UK; Department of Infectious Diseases, University College London Hospital, London, UK. Electronic address:
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