Predictors Of Catastrophic Costs Of Tuberculosis (TB) Among Patients Co-Affected With TB-HIV And TB-Diabetes In Bhavnagar Region, Western India

Mihir Rupani; Sheetal  Vyas

doi:10.55489/njcm.130820222251

Authors

Mihir Rupani Government Medical College Bhavnagar (Maharaja Krishnakumarsinhji Bhavnagar University), Bhavnagar, Gujarat, India; Clinical Epidemiology (Division of Health Sciences), ICMR - National Institute of Occupational Health (NIOH), Ahmedabad, India; Ph.D. scholar affiliated to Gujarat University, Ahmedabad, India https://orcid.org/0000-0003-2174-1345
Sheetal Vyas AMC-MET Medical College, Ahmedabad, India; Ph.D. guide affiliated to Gujarat University, Ahmedabad, India

DOI:

https://doi.org/10.55489/njcm.130820222251

Keywords:

tuberculosis-human immunodeficiency virus, tuberculosis-diabetes, cost of illness, healthcare costs, tuberculosis elimination, national tuberculosis elimination program

Abstract

Background: By the year 2030, no family with a patient of tuberculosis (TB) is supposed to incur catastrophic costs. In India, a significant number of people suffer from TB, and many face catastrophic costs. Our objective was to determine the predictors of catastrophic costs due to TB among co-prevalent TB-HIV and TB-diabetes patients.

Methods: We conducted a cross-sectional study among 234 patients co-affected with TB-HIV and 304 patients with TB-diabetes co-prevalence in the Bhavnagar region (western part of India). TB costs, estimated using a validated questionnaire, were defined to be catastrophic when they exceeded 20% of annual household income. Multivariable logistic regression was used to determine the significant predictors of catastrophic costs of TB.

Results: Four percent of patients in each group incurred catastrophic costs due to TB. Female gender [adjusted odds ratio aOR 6 (95% CI 1.2-33)], being single [aOR 9 (95% CI 1.5-52)], low socioeconomic status [aOR 7 (95% CI 1.2-30)], private consultation for TB [aOR 9 (95% CI 1.5-53)], and hospitalization in first HIV visit [aOR 19 (95% CI 3-137)] significantly predicted catastrophic costs of TB among patients co-affected with TB-HIV. Among patients with TB-diabetes co-prevalence, hospitalization in first TB visit [aOR 7 (95% CI 2-29)], and private consultation for TB [aOR 7 (95% CI 1.6-30)] were the significant predictors.

Conclusions: Despite a lower percentage of TB-HIV/ TB-diabetes patients facing catastrophic costs, hospitalization and private care-seeking are the “modifiable” determinants of TB catastrophic costs in our study setting.

References

World Health Organization. Global Tuberculosis Report 2021 [Internet]. Geneva: World Health Organization; 2021. Available from: https://apps.who.int/iris/rest/bitstreams/1379788/retrieve

Central TB Division (Ministry of Health and Family Welfare. Government of India). India TB report 2022, Coming Together to End TB Altogether [Internet]. New Delhi, India, 2022 [cited 2022 Jul 8]. Available from: https://tbcindia.gov.in/WriteReadData/IndiaTBReport2022/TBAnnaulReport2022.pdf

World Health Organization. The End TB Strategy [Internet]. Geneva, Switzerland: WHO Press, Geneva, Switzerland; 2015 [cited 2022 Jul 10]. Available from: https://apps.who.int/iris/rest/bitstreams/1271371/retrieve

World Health Organization. Tuberculosis patient cost surveys: a handbook [Internet]. Geneva, Switzerland: WHO Press, Geneva, Switzerland; 2017. Available from: https://apps.who.int/iris/rest/bitstreams/1092601/retrieve

Chandra A, Kumar R, Kant S, Parthasarathy R, Krishnan A. Direct and indirect patient costs of tuberculosis care in India. Trop Med Int Heal [Internet]. 2020 Jul 12;25(7):803-12. Doi: https://doi.org/10.1111/tmi.13402 PMid:32306481

Rupani MP, Cattamanchi A, Shete PB, Vollmer WM, Basu S, Dave JD. Costs incurred by patients with drug-susceptible pulmonary tuberculosis in semi-urban and rural settings of Western India. Infect Dis Poverty [Internet]. 2020 Dec 19;9(1):144. Doi: https://doi.org/10.1186/s40249-020-00760-w PMid:33076969 PMCid:PMC7574230

Ghazy RM, El Saeh HM, Abdulaziz S, Hammouda EA, Elzorkany AM, Khidr H, et al. A systematic review and meta-analysis of the catastrophic costs incurred by tuberculosis patients. Sci Rep [Internet]. 2022;12(1):1-16. Doi: https://doi.org/10.1038/s41598-021-04345-x PMid:35017604 PMCid:PMC8752613

Wingfield T, Boccia D, Tovar M, Gavino A, Zevallos K, Montoya R, et al. Defining Catastrophic Costs and Comparing Their Importance for Adverse Tuberculosis Outcome with Multi-Drug Resistance: A Prospective Cohort Study, Peru. Ruger JP, editor. PLoS Med [Internet]. 2014 Jul 15;11(7):e1001675. Doi: https://doi.org/10.1371/journal.pmed.1001675 PMid:25025331 PMCid:PMC4098993

Muniyandi M, Rao V, Bhat J, Yadav R, Sharma R. Household Catastrophic Health Expenditure Due To Tuberculosis: Analysis From Particularly Vulnerable Tribal Group, Central India. Med Mycol Open Access. 2016;2(1):1-9. Doi: https://doi.org/10.21767/2471-8521.100009

Duan W, Zhang W, Wu C, Wang Q, Yu Y, Lin H, et al. Extent and determinants of catastrophic health expenditure for tuberculosis care in Chongqing municipality, China: a cross-sectional study. BMJ Open [Internet]. 2019 Apr 11;9(4):e026638. Doi: https://doi.org/10.1136/bmjopen-2018-026638 PMid:30975682 PMCid:PMC6500361

Laokri S, Dramaix-Wilmet M, Kassa F, Anagonou S, Dujardin B. Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities. Trop Med Int Heal [Internet]. 2014 Oct 1 [cited 2022 Jul 3];19(10):1249-58. Doi: https://doi.org/10.1111/tmi.12365 PMid:25040399

Fuady A, Houweling TAJ, Mansyur M, Richardus JH. Catastrophic total costs in tuberculosis-affected households and their determinants since Indonesia's implementation of universal health coverage. Infect Dis Poverty [Internet]. 2018 Dec 12;7(1):3. Doi: https://doi.org/10.1186/s40249-017-0382-3 PMid:29325589 PMCid:PMC5765643

Muniyandi M, Thomas BE, Karikalan N, Kannan T, Rajendran K, Saravanan B, et al. Association of Tuberculosis With Household Catastrophic Expenditure in South India. JAMA Netw open. 2020;3(2):e1920973. Doi: https://doi.org/10.1001/jamanetworkopen.2019.20973 PMid:32049293

Ukwaja KN, Alobu I, Abimbola S, Hopewell PC. Household catastrophic payments for tuberculosis care in Nigeria: incidence, determinants, and policy implications for universal health coverage. Infect Dis Poverty [Internet]. 2013 Sep 17 [cited 2022 Jul 7];2(1):21. Doi: https://doi.org/10.1186/2049-9957-2-21 PMid:24044368 PMCid:PMC3848689

Zhou C, Long Q, Chen J, Xiang L, Li Q, Tang S, et al. Factors that determine catastrophic expenditure for tuberculosis care: a patient survey in China. Infect Dis Poverty [Internet]. 2016 Dec 25;5(1):6. Doi: https://doi.org/10.1186/s40249-016-0100-6 PMid:26806552 PMCid:PMC4724959

Kilale AM, Pantoja A, Jani B, Range N, Ngowi BJ, Makasi C, et al. Economic burden of tuberculosis in Tanzania: a national survey of costs faced by tuberculosis-affected households. BMC Public Health [Internet]. 2022 Dec 29 [cited 2022 Jul 7];22(1):600. Doi: https://doi.org/10.1186/s12889-022-12987-3 PMid:35351063 PMCid:PMC8961947

Ellaban MM, Basyoni NI, Boulos DNK, Rady M, Gadallah M. Assessment of Household Catastrophic Total Cost of Tuberculosis and Its Determinants in Cairo: Prospective Cohort Study. Tuberc Respir Dis (Seoul) [Internet]. 2022 Apr 1 [cited 2022 Jul 7];85(2):165-74. Doi: https://doi.org/10.4046/trd.2021.0028 PMid:34814238 PMCid:PMC8987667

Pedrazzoli D, Carter DJ, Borghi J, Laokri S, Boccia D, Houben RM. Does Ghana's National Health Insurance Scheme provide financial protection to tuberculosis patients and their households? Soc Sci Med [Internet]. 2021 May 1 [cited 2022 Jul 7];277:113875. Doi: https://doi.org/10.1016/j.socscimed.2021.113875 PMid:33848718

Timire C, Ngwenya M, Chirenda J, Metcalfe JZ, Kranzer K, Pedrazzoli D, et al. Catastrophic costs among tuberculosis‐affected households in Zimbabwe: A national health facility‐based survey. Trop Med Int Heal [Internet]. 2021 Oct 3 [cited 2022 Jul 7];26(10):1248-55. Doi: https://doi.org/10.1111/tmi.13647 PMid:34192392 PMCid:PMC8519355

Kirubi B, Ong'ang'o J, Nguhiu P, Lönnroth K, Rono A, Sidney-Annerstedt K. Determinants of household catastrophic costs for drug sensitive tuberculosis patients in Kenya. Infect Dis Poverty [Internet]. 2021 Dec 5 [cited 2022 Jul 7];10(1):95. Doi: https://doi.org/10.1186/s40249-021-00879-4 PMid:34225790 PMCid:PMC8256229

Yang T, Chen T, Che Y, Chen Q, Bo D. Factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in China. BMC Public Health [Internet]. 2020 Dec 26 [cited 2022 Jul 7];20(1):1009. Doi: https://doi.org/10.1186/s12889-020-09136-z PMid:32586305 PMCid:PMC7318445

Stracker N, Hanrahan C, Mmolawa L, Nonyane B, Tampi R, Tucker A, et al. Risk factors for catastrophic costs associated with tuberculosis in rural South Africa. Int J Tuberc Lung Dis [Internet]. 2019 Jun 1 [cited 2022 Jul 7];23(6):756-63. Doi: https://doi.org/10.5588/ijtld.18.0519 PMid:31315710 PMCid:PMC6755915

Aung S, Thu A, Aung H, Thu M. Measuring Catastrophic Costs Due to Tuberculosis in Myanmar. Trop Med Infect Dis [Internet]. 2021 Jul 14 [cited 2022 Jul 3];6(3):130. Doi: https://doi.org/10.3390/tropicalmed6030130 PMid:34287379 PMCid:PMC8293353

Central TB Division (Government of India) and WHO Country Office for India. Standards for TB care in India [Internet]. New Delhi, India: World Health Organization; 2014 [cited 2018 Dec 12]. Available from: https://tbcindia.gov.in/showfile.php?lid=3061

Walcott RL, Ingels JB, Corso PS, Zalwango S, Whalen CC, Sekandi JN. There's no such thing as a free TB diagnosis: Catastrophic TB costs in Urban Uganda. Glob Public Health [Internet]. 2020 Jun 2 [cited 2022 Jul 7];15(6):877-88. Doi: https://doi.org/10.1080/17441692.2020.1724313 PMid:32027555 PMCid:PMC7225044

Wang Y, McNeil EB, Huang Z, Chen L, Lu X, Wang C, et al. Household financial burden among multidrug-resistant tuberculosis patients in Guizhou province, China. Medicine (Baltimore) [Internet]. 2020 Jul 10 [cited 2022 Jul 7];99(28):e21023. Doi: https://doi.org/10.1097/MD.0000000000021023 PMid:32664107 PMCid:PMC7360282