塔吉克斯坦的一项患者调查：不同结核病治疗阶段的疾病家庭负担。
Household costs of illness during different phases of tuberculosis treatment in Central Asia: a patient survey in Tajikistan.
机构信息
Swiss Tropical Institute, Swiss Centre for International Health, Socinstr, 57 4002 Basel, Switzerland.
出版信息
BMC Public Health. 2010 Jan 18;10:18. doi: 10.1186/1471-2458-10-18.
BACKGROUND
Illness-related costs incurred by patients constitute a severe economic burden for households especially in low-income countries. High household costs of illness lead to impoverishment; they impair affordability and equitable access to health care and consequently hamper tuberculosis (TB) control. So far, no study has investigated patient costs of TB in the former Soviet Union.
METHODS
All adult new pulmonary TB cases enrolled into the DOTS program in 12 study districts during the study period were enrolled. Medical and non-medical expenditure as well as loss of income were quantified in two interviews covering separate time periods. Costs of different items were summed up to calculate total costs. For missing values, multiple imputation was applied.
RESULTS
A cohort of 204 patients under DOTS, 114 men and 90 women, participated in the questionnaire survey. Total illness costs of a TB episode averaged $1053 (c. $4900 purchasing power parity, PPP), of which $292, $338 and $422 were encountered before the start of treatment, during intensive phase and in continuation phase, respectively. Costs per month were highest before the start of treatment ($145) and during intensive phase ($153) and lower during continuation phase ($95). These differences were highly significant (paired t-test, p < 0.0005 for both comparisons).
CONCLUSIONS
The illness-related costs of an episode of TB exceed the per capita GDP of $1600 PPP about two-and-a-half times. Hence, these costs are catastrophic for concerned households and suggest a high risk for impoverishment. Costs are not equally spread over time, but peak in early stages of treatment, exacerbating the problem of affordability. Mitigation strategies are needed in order to control TB in Tajikistan and may include social support to the patients as well as changes in the management of TB cases. These mitigation strategies should be timed early in treatment when the cost burden is highest.
背景
患者的疾病相关费用给家庭带来了严重的经济负担，尤其是在低收入国家。高昂的医疗费用会导致贫困，影响医疗保健的可负担性和公平性，从而阻碍结核病（TB）的控制。迄今为止，尚无研究调查前苏联国家的结核病患者费用。
方法
在研究期间，在 12 个研究区纳入所有新入组直接督导下短程化疗（DOTS）项目的成年肺结核患者。在两次访谈中分别定量评估医疗和非医疗支出以及收入损失。将不同项目的费用加总计算总费用。对于缺失值，采用多重插补法进行处理。
结果
共有 204 名接受 DOTS 治疗的患者参与了问卷调查，其中男性 114 人，女性 90 人。一个结核病发作的总疾病费用平均为 1053 美元（购买力平价约为 4900 美元），其中在治疗开始前、强化期和继续期分别为 292 美元、338 美元和 422 美元。治疗开始前（145 美元）和强化期（153 美元）每月费用最高，继续期费用较低（95 美元）。这些差异具有统计学意义（配对 t 检验，p < 0.0005）。
结论
一次结核病发作的相关费用超过了人均购买力平价 1600 美元的两倍半。因此，这些费用对相关家庭来说是灾难性的，表明贫困风险很高。费用不是平均分布在整个时间内，而是在治疗早期达到峰值，加剧了可负担性问题。为了在塔吉克斯坦控制结核病，需要采取缓解策略，包括对患者的社会支持以及结核病病例管理方式的改变。这些缓解策略应在治疗早期费用负担最高时尽早实施。
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