Expenditure Incurred by Patients of Pulmonary and Extrapulmonary Tuberculosis Under Revised National Tuberculosis Control Programme in District Tuberculosis Center, Jammu

Authors

  • Anuradha Kalotra Government Medical College, Jammu, J&K, India
  • Dinesh Kumar All India Institutional of Medical Sciences, Vijaypur, Jammu, J&K, India
  • Ravi Kumar Government Medical College, Kathua, Jammu, J&K ,India
  • Arvind Kumar yadav Akal University, Bathinda, Punjab, India
  • Kiran Lachala Government Medical College, Jammu, J&K, India
  • Bhavna Sahni ASCOMS and Hospital, Sidhra, Jammu, J&K, India

DOI:

https://doi.org/10.55489/njcm.140320232609

Keywords:

Tuberculosis, Health Expenditures, Hospital costs, Health Care costs, Cost of Illness, Out of Pocket Expenditure, Indirect, Expenditures

Abstract

Background: Tuberculosis (TB) patients suffer enormously due to huge cost on diagnosis and treatment. This study aims to assess the total expenditure and its predictors among patients of TB.

Methodology: A longitudinal study was conducted among TB Patients registered in first quarter of 2018 at District Tuberculosis Center, Jammu. Data was collected by interviewing the patients and their attendants. Statistical significance of median expenditure between patients of pulmonary and extrapulmonary TB in relation to various predictors was assessed using nonparametric tests followed by Multiple Linear Regression.

Results: Total median cost, median direct and indirect cost incurred by a TB patient were recorded as USD 489.55, USD 246.55 and USD 229.5 respectively. Treatment costs were slightly higher in patients of pulmonary TB in comparison to extrapulmonary TB (p>0.05). On bivariate analysis, upper class, previously treated patients, Category 2 patients, with chronic illnesses, with guardians and who were employed expended significantly higher amounts on their treatment, but on multivariate analysis, only formal employment, current earning and being reimbursed significantly predicted the total cost (p < .001, adjusted R square = 0.56).

Conclusion: Huge direct costs incurred by patients is a matter of great concern, more so as the Indian government has made all diagnostics and treatment free since the inception of the RNTCP.

References

World Health Organisation. Global Tuberculosis Report. World Health Organisation.2016. Geneva: WHO; 2016. Available from: http://www.who.int/tb/publications/global_report/en.[Accessed January 22, 2022]

Revised National Tb Control Programme. Tb India Annual Status Report. Ministry of family and health welfare 2015. Available from:https://tbcindia.gov.in.[Accessed January 14, 2022]

World Health Organisation. Global Tuberculosis Report. World Health Organisation.2018. Geneva: WHO; 2018. Available from: http://www.who.int/tb/publications/global_report/en[Accessed January 12, 2022]

Kumar Prahlad. Journey Of Tuberculosis Control Movement in India: National TuberculosisProgramme to Revised National Tuber-culosis Control Programme. Indian J Tuberc2005;52:63-71.

Revised National Tb Control Programme. Technical and Operational Guidelines for Tuberculosis Control in India. Ministry of family and health welfare 2016.Available from https://tbcindia. gov.in.[Accessed January 21, 2022]

Shrivasstava SRB, Shrivastava PS, Ramasamy J. Notification of Tuberculosis Cases in India:Moving ahead in Revised National Tuber-culosis Control Program. Infect Ecol Epidemiol2013;3:1-2. Doi: https://doi.org/10.3402/iee.v3i0.23006 PMid:24260705 PMCid:PMC3833920

Shefali D, Sunil K. Nikshay Online Tool for Monitoring TB Control programme.Jan.08,2013. Available from: http://ehealth.eletsonline. com/2013/01/nikshay-online-tool-for-monitoring-tb-control-programme.[Accessed January 12, 2022]

WHO End TB Strategy. Tuberculosis. Global strategy and targets for TB prevention, care and control after 2015.Available from: http://www.who.int/tb/post2015_strategy/en.[Accessed January 16, 2022]

Padmapriyadarsini C, Shobana M, Lakshmi M, Beena T & Soumya S. Undernutrition & Tuberculosis in India: Situational analysis & the way forward. Indian J Med Res. Jul 2016;144(1):11-20. Doi: https://doi.org/10.4103/0971-5916.193278 PMid:27834321 PMCid:PMC5116882

World Health Organisation. Systematic Screening for Active Tuberculosis: Principles and recommendations. World Health Organisa-tion 2013. Available from: http://www.who.int/tb/ publications/Final_TB_Screening_guidelines.pdf.[Accessed December 21, 2021]

Ahlburg, Dennis A. The Economic Impacts of Tuberculosis. Mar. 2000;5-29. WHOCDSSTB2000-5. Available from: http://apps.who. int/iris/handle//66238.[Accessed January 24, 2022]

Santos MLSG, Vendramini SHF, Gazetta CE, Oliveira SAC, Villa TCS. Poverty: Socioeconomic characterization at Tuberculosis. Rev Latino. Am Emfermagem2007;15:762-7. Doi: https://doi.org/10.1590/S0104-11692007000700008 PMid:17934582

World Health Organisation. Bending the curve-ending TB.Annual Report 2017. Available from: http://apps.who.int/iris/bitstream/ 10665/254762/1/978929022584-eng.pd.[Accessed January 6, 2022]

Muniyandi M, Rajeswari R, Rani B. Costs to Patients with Tuberculosis treated under DOTS Programme. Indian J Tuberc. 2005;52:188-96.

Tadayaki T, Ernesto J, Diana W, Mario R, Knut L. Financial burden for Tuberculosis patients in low and middle income-a systematic review. Eur Respir J 2014 Jun;43(6):1763-75. Doi: https://doi.org/10.1183/09031936.00193413 PMid:24525439 PMCid:PMC4040181

World Health Organisation. Standards for TB care in India: Ministry of Health and Family Welfare 2014.Available from: https://tbcindia.gov.in.[Accessed January 20, 2022]

Spotlight: Tool to estimate patients costs. Stop TB Partnership. Available at:https://stoptb.org/wg/dots_expansion/tbandpoverty/spotlight.asp [Accessed January 24, 2022].

Central TB Division. Government of India. Nutritional Support to TB patients(NikshayPoshanYojana). New Delhi: Ministry of Health & Family Welfare,Government of India; 2018.

Pandey VK, Aggarwal P, Kakkar R.Modified BG Prasad Socio-economic Classification, Update -2019.Indian J Comm Health. 2019; 31, 1: 123-125. Doi: https://doi.org/10.47203/IJCH.2019.v31i01.025

John KR, Daley P, Kincler N, Oxlade O, Menzies D. Costs incurred by patients with pulmonary tuberculosis in rural India. Int J Tuberc Lung Dis. 2009 Oct;13(10):1281-7.

Siapka M, Vassall A, Cunnama L, Pineda C, Cerecero D, Sweeney S, et al. Cost of tuberculosis treatment in low- and middle-income countries: systematic review and meta-regression. Int J Tuberc Lung Dis. 2020 Aug 1;24(8):802-810.] Doi: https://doi.org/10.5588/ijtld.19.0694 PMid:32912385

Kik SV, Olthof SP, de Vries JT, Menzies D, Kincler N, van Loenhout-Rooyakkers J, Burdo C, Verver S. Direct and indirect costs of tu-berculosis among immigrant patients in the Netherlands. BMC Public Health. 2009 Aug 5;9:283. Doi: https://doi.org/10.1186/1471-2458-9-283 PMid:19656370 PMCid:PMC2734849

Atif M, Sulaiman SA, Shafie AA, Asif M, Babar ZU. Resource utilization pattern and cost of tuberculosis treatment from the provider and patient perspectives in the state of Penang, Malaysia. BMC Health Serv Res. 2014 Aug 19;14:353. Doi: https://doi.org/10.1186/1472-6963-14-353 PMid:25138659 PMCid:PMC4156630

Ukwaja KN, Alobu I, Lgwenyi C, Hopewell PC. The high cost of free tuberculosis services: patient and household costs associated with tuberculosis care in Ebonyi State, Nigeria. PLoS One. 2013 Aug 27;8(8):e73134. Doi: https://doi.org/10.1371/journal.pone.0073134 PMid:24015293 PMCid:PMC3754914

Sinha P, Carwile M, Bhargava A, Cintron C, Acuna-Villaorduna C, Lakshminarayan S, Liu AF, Kulatilaka N, Locks L, Hochberg NS. How much do Indians pay for tuberculosis treatment? A cost analysis. Public Health Action. 2020 Sep 21;10(3):110-117. Doi: https://doi.org/10.5588/pha.20.0017 PMid:33134125 PMCid:PMC7577002

Asres A, Jerene D, Deressa W. Pre- and post-diagnosis costs of tuberculosis to patients on Directly Observed Treatment Short course in districts of southwestern Ethiopia: a longitudinal study. J Health PopulNutr. 2018 May 21;37(1):15. Doi: https://doi.org/10.1186/s41043-018-0146-0 PMid:29784037 PMCid:PMC5963051

Othman GQ, Ibrahim MI, Raja'a YA. Costs associated with tuberculosis diagnosis and treatment in Yemen for patients and public health services. East Mediterr Health J. 2012 Apr;18(4):393-8. Doi: https://doi.org/10.26719/2012.18.4.393 PMid:22768704

Sajith, M., A. Thomas, J. J. Kothia, B. Chandrakar, A. Pawar, and M. D. Bargaje. Cost of therapy incurred for tuberculosis patients re-ceiving directly observed therapy (DOT). International Journal of Pharmacy and Pharmaceutical Sciences, vol. 7, no. 11, Oct. 2015, pp. 141-4.

Chandra, A., Kumar, R., Kant, S., Parthasarathy, R. and Krishnan, A. (2020), Direct and indirect patient costs of tuberculosis care in India. Trop Med Int Health, 25: 803-812. Doi: https://doi.org/10.1111/tmi.13402 PMid:32306481

Bay V, Tabarsi P, Rezapour A, Marzban S, Zarei E. Cost of tuberculosis treatment: evidence from Iran's health system. Osong public health and research perspectives. 2017 Oct;8(5):351. Doi: https://doi.org/10.24171/j.phrp.2017.8.5.09 PMid:29164047 PMCid:PMC5678196

Downloads

Published

2023-03-31

How to Cite

1.
Kalotra A, Kumar D, Kumar R, yadav AK, Lachala K, Sahni B. Expenditure Incurred by Patients of Pulmonary and Extrapulmonary Tuberculosis Under Revised National Tuberculosis Control Programme in District Tuberculosis Center, Jammu. Natl J Community Med [Internet]. 2023 Mar. 31 [cited 2024 May 14];14(03):139-46. Available from: https://njcmindia.com/index.php/file/article/view/2609

Issue

Section

Original Research Articles