Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands.
Rev Panam Salud Publica. 2013 May;33(5):332-9. doi: 10.1590/s1020-49892013000500004.
To examine direct and indirect costs incurred by new, retreatment, and multidrug-resistant (MDR) tuberculosis (TB) patients in the Dominican Republic before and during diagnosis, and during treatment, to generate an evidence base and formulate recommendations.
The "Tool to Estimate Patients' Costs" was adapted to the local setting, translated into Spanish, and pretested. Patients attending 32 randomly selected health facilities in six chosen study areas on the study days were interviewed. Responses from patients 18-65 years old who had received treatment for at least one month and provided signed informed consent were collected, entered into a database, and analyzed.
A total of 200 patients were interviewed. For most respondents, direct and indirect costs increased while income decreased. Total costs amounted to a median of US$ 908 for new patients, US$ 432 for retreatment patients, and US$ 3 557 for MDR-TB patients. The proportion of patients without a regular income increased from 1% to 54% because of falling ill with TB. Following its review of the study results the Ministry of Health has made efforts to allocate public funds for food supplements and to include in- and outpatient TB services in the national health insurance schemes.
Free TB diagnosis and treatment are not enough to alleviate the financial constraints experienced by vulnerable groups as a result of the illness. Health insurance covering TB in- and outpatient costs is critical to prevent TB-related financial hardship.
在多米尼加共和国，检查新诊断、复治和耐多药（MDR）结核病（TB）患者在诊断前、诊断时和治疗期间产生的直接和间接费用，为制定建议提供依据。
对“患者费用估计工具”进行了调整，以适应当地情况，翻译成西班牙语，并进行了预测试。在选定的研究区域的 32 个随机选择的卫生机构的研究日，对就诊的患者进行了访谈。收集了至少接受了一个月治疗并签署了知情同意书的 18-65 岁患者的回答，将其输入数据库进行分析。
共访谈了 200 名患者。对于大多数受访者，直接和间接费用增加，而收入减少。新患者的总费用中位数为 908 美元，复治患者为 432 美元，MDR-TB 患者为 3557 美元。由于患结核病，没有固定收入的患者比例从 1%增加到 54%。在审查了研究结果后，卫生部已努力分配公共资金用于食品补充剂，并将门诊和住院结核病服务纳入国家健康保险计划。
免费的结核病诊断和治疗不足以缓解弱势群体因患病而面临的财务限制。涵盖结核病门诊和住院费用的健康保险对于防止与结核病相关的经济困难至关重要。
