确定印度德里大都市中在国家结核病防治规划（RNTCP）下登记的结核病患者中导致灾难性支出的费用。

Identifying costs contributing to catastrophic expenditure among TB patients registered under RNTCP in Delhi metro city in India.

作者信息

Sarin Rohit, Vohra Vikram, Singla Neeta, Thomas Beena, Krishnan Rajendran, Muniyandi Malaisamy

机构信息

National Institute of Tuberculosis & Respiratory Diseases, Sri Aurobindo Marg, Delhi 110030, India.

出版信息

Indian J Tuberc. 2019 Jan;66(1):150-157. doi: 10.1016/j.ijtb.2018.10.009. Epub 2018 Nov 7.

DOI:10.1016/j.ijtb.2018.10.009

PMID:30797274

Abstract

BACKGROUND

Tuberculosis (TB) patients often incur large costs related to illness, as well as for seeking and receiving health care. Despite TB treatment being free under RNCTP, out of pocket expenditure incurred (OOP) by patients for TB diagnosis and treatment impoverishes the households. This expenditure may turn catastrophic (more than 20% of their family income) impacting adherence and leading to poor treatment outcomes.

OBJECTIVE

To estimate the proportion of households experiencing catastrophic expenditure due to TB and also to find out the various costs contributing to catastrophic expenditure.

METHODS

In this cohort study, 450 TB patients (including 96 children) registered under Revised National Tuberculosis Control Programme (RNTCP) in Delhi were interviewed at three different time points (in the beginning of treatment, end of intensive phase, end of treatment). Interview schedule was used to collect information on direct medical and non-medical, and indirect costs. The TB-specific indicator of "catastrophic total costs" incorporates both, direct medical and non-medical payments for treatment such as transportation, lodging charges and indirect costs such as wage loss.

RESULTS

A total of 450 patients were enrolled in this study, out of which 425 were followed up to the end of treatment. It was observed that 7% of TB patients registered under RNTCP in Delhi experienced catastrophic expenditure due to TB. The total mean cost to patients with TB was Rs. 12165 (Rs. 1406 during diagnosis and Rs. 10759 during treatment). The indirect cost was higher compared to direct cost i.e.Rs. 7564 and Rs. 4601 respectively).

CONCLUSION

This information will be useful for policy makers to design an intervention to provide financial protection to TB patients. In addition, findings of this study will aid in providing baseline evidence to periodically measure the OOP which is the one of the End TB strategy target.

摘要

背景

结核病患者通常会产生与疾病相关的巨额费用，以及寻求和接受医疗保健的费用。尽管根据修订后的国家结核病控制规划（RNCTP），结核病治疗是免费的，但患者在结核病诊断和治疗方面的自付费用使家庭陷入贫困。这种支出可能会变成灾难性的（超过其家庭收入的20%），影响治疗依从性并导致治疗效果不佳。

目的

估计因结核病而经历灾难性支出的家庭比例，并找出导致灾难性支出的各种费用。

方法

在这项队列研究中，对德里根据修订后的国家结核病控制规划（RNTCP）登记的450名结核病患者（包括96名儿童）在三个不同时间点（治疗开始时、强化期结束时、治疗结束时）进行了访谈。使用访谈时间表收集有关直接医疗和非医疗以及间接费用的信息。“灾难性总成本”这一结核病特定指标包括治疗的直接医疗和非医疗费用，如交通、住宿费用以及间接费用，如工资损失。