Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, Liverpool, UK.
De La Salle Medical and Health Sciences Institute, Cavite, The Philippines.
Int J Tuberc Lung Dis. 2020 Apr 1;24(4):420-427. doi: 10.5588/ijtld.19.0206.
Eight tuberculosis treatment sites in Cavite Province, the Philippines, including two sites specialising in management of multidrug-resistant tuberculosis (MDR-TB). To evaluate costs incurred by TB patients and to determine the proportion of households that faced catastrophic costs, then to consider cost survey responses alongside results of detailed patient-pathway modelling. Clustered cross-sectional survey using a field testing version of the WHO TB patient-costing tool and protocol; face-to-face interviews with 194 patients conducted in May-August 2016. Costs included direct-medical, direct non-medical and indirect costs using the human capital approach. Patients were deemed to incur catastrophic expenditure if TB-related costs exceeded 20% of annual household income. Patient pathways were modelled following multiple health staff interviews. Estimated mean cost incurred by patients with drug-susceptible TB was US$321 vs. $2356 for MDR-TB patients. Catastrophic costs were suffered by 28% of drug-susceptible and 80% of MDR-TB patients, with lost income being the largest contributor. Patient-pathway modelling suggested most patients had under-reported health visits. Survey results indicate that patient costs are large for all patients in Cavite, particularly for MDR-TB patients. Patient-pathway modelling suggests these costs are an underestimate due to poor recollection of health visits, suggesting that the WHO instrument and protocol could be improved to better capture the diagnostic journey.
菲律宾卡维特省的 8 个结核病治疗点，包括 2 个专门管理耐多药结核病（MDR-TB）的地点。评估结核病患者的费用，并确定面临灾难性费用的家庭比例，然后结合详细的患者路径建模结果考虑成本调查的回复。使用世界卫生组织结核病患者成本核算工具和方案的现场测试版本进行聚类横断面调查；2016 年 5 月至 8 月对 194 名患者进行面对面访谈。采用人力资本方法，将直接医疗、直接非医疗和间接成本纳入成本核算。如果结核病相关费用超过家庭年收入的 20%，则认为患者发生灾难性支出。根据多次卫生工作人员访谈对患者的路径进行建模。耐多药结核病患者的估计平均费用为 321 美元，而耐多药结核病患者为 2356 美元。28%的耐多药结核病患者和 80%的耐多药结核病患者发生灾难性支出，其中收入损失是最大的贡献者。患者路径建模表明，大多数患者报告的健康就诊次数不足。调查结果表明，卡维特省所有患者的患者费用都很高，尤其是耐多药结核病患者。患者路径建模表明，由于对健康就诊的记忆不佳，这些成本被低估了，这表明世卫组织的工具和方案可以得到改进，以更好地捕捉诊断过程。
