de Cuevas Rachel M Anderson, Lawson Lovett, Al-Sonboli Najla, Al-Aghbari Nasher, Arbide Isabel, Sherchand Jeevan B, Nnamdi Emenyonu E, Aseffa Abraham, Yassin Mohammed A, Abdurrahman Saddiq T, Obasanya Joshua, Olanrewaju Oladimeji, Datiko Daniel, Theobald Sally J, Ramsay Andrew, Squire S Bertel, Cuevas Luis E
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
Zankli Medical Center, Abuja, Nigeria.
Infect Dis Poverty. 2016 Mar 24;5:24. doi: 10.1186/s40249-016-0117-x.
A major impediment to the treatment of TB is a diagnostic process that requires multiple visits. Descriptions of patient costs associated with diagnosis use different protocols and are not comparable.
We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis. Surveys of 2225 adults attending smear-microscopy centres in Nigeria, Nepal, Ethiopia and Yemen. Adults >18 years with cough >2 weeks were enrolled prospectively. Direct costs were quantified using structured questionnaires. Patients with costs >75(th) quartile were considered to have high expenditure (cases) and compared with patients with costs <75(th) quartile to identify factors associated with high expenditure.
The most significant expenses were due to clinic fees and transport. Most participants attended the centres with companions. High expenditure was associated with attending with company, residing in rural areas/other towns and illiteracy.
The costs incurred by patients are substantial and share common patterns across countries. Removing user fees, transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs. In locations with limited resources, support could be prioritised for those most at risk of high expenditure; those who are illiterate, attend the service with company and rural residents.
结核病治疗的一个主要障碍是诊断过程需要多次就诊。关于与诊断相关的患者费用的描述采用了不同的方案，且无法进行比较。
我们旨在描述四个国家结核病诊断中心成年患者的直接费用以及与诊断支出相关的因素。对尼日利亚、尼泊尔、埃塞俄比亚和也门2225名前往涂片显微镜检查中心的成年人进行了调查。前瞻性纳入年龄大于18岁且咳嗽超过2周的成年人。使用结构化问卷对直接费用进行量化。费用高于第75百分位数的患者被视为高支出患者（病例组），并与费用低于第75百分位数的患者进行比较，以确定与高支出相关的因素。
最主要的费用是诊费和交通费。大多数参与者就诊时有人陪同。高支出与有人陪同就诊、居住在农村地区/其他城镇以及文盲有关。
患者产生的费用很高，且各国存在共同模式。取消用户费用、实行透明的收费政策以及报销诊所费用将减少直接诊断费用对贫困的影响。在资源有限的地区，可以优先为高支出风险最大的人群提供支持；即文盲、有人陪同就诊的人和农村居民。
