Poornima M P, Shruthi M N, Chingale Ashwini Laxmanrao, Veena V, Nagaraja Sharath Burugina, Madhukeshwar Akshaya Kibballi
Department of Community Medicine, Jagadguru Jayadeva Murugarajendra Medical College, Davangere, Karnataka, India.
Department of Community Medicine, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.
Tuberc Res Treat. 2020 May 11;2020:3845694. doi: 10.1155/2020/3845694. eCollection 2020.
TB diagnostic and treatment services in India are provided free of cost in the programmatic context across the country. There are different costs incurred during health care utilization, and this study was conducted to estimate such costs. . A longitudinal study was conducted among patients of three urban tuberculosis units (TUs) of Davangere, Belagavi, and Bengaluru, Karnataka. Trained data collectors administered a validated questionnaire and recorded monthly costs incurred by the patients which are expressed in median Indian National Rupees (INR). The analysis was done using SPSS version 23.0. A value of <0.05 was taken as statistically significant.
Among 214 patients, about 37%, 42%, and 21% belonged to Davangere, Belagavi, and Bengaluru, respectively. Median total pre- and postdiagnostic costs incurred across the three TUs were 3800 and 4000 INR, respectively. The direct nonmedical cost was higher for accommodation (median cost of 800 INR) and direct medical cost for non-TB drugs (median cost of 2000 INR). However, maximum direct medical and nonmedical costs were attributed to hospital admissions (1200 INR) and accommodation costs (700 INR) in the postdiagnostic period, respectively. The median indirect cost incurred was 300 INR overall, and the maximum total indirect cost was 40000 INR in the postdiagnostic period. About one-third of patients faced loss of income and 19.6% faced coping costs. Patients spent about 6.7% (0.97%-52.3%) of their income on TB treatment. About 12.3% patients faced catastrophic expenditure. Median cost was significantly higher among those seeking private health care facilities (12100 INR in private vs. 6800 INR in public; < 0.05) during the prediagnostic period. Prediagnostic and diagnostic out-of-pocket expenditures (OPE) were significantly higher across all the three centres ( < 0.05).
The TB patients experienced untoward expenditure under programmatic settings. The costs encountered by one in eight patients were catastrophic by nature.
在印度，全国性的结核病诊断和治疗服务是免费提供的。在医疗保健利用过程中会产生不同的费用，本研究旨在估算此类费用。在卡纳塔克邦达万盖雷、贝拉尔加维和班加罗尔的三个城市结核病防治单位（TUs）的患者中进行了一项纵向研究。经过培训的数据收集人员发放了一份经过验证的问卷，并记录了患者每月产生的费用，这些费用以印度国家卢比（INR）中位数表示。使用SPSS 23.0版本进行分析。P值<0.05被视为具有统计学意义。
在214名患者中，分别约有37%、42%和21%来自达万盖雷、贝拉尔加维和班加罗尔。三个结核病防治单位诊断前和诊断后的总费用中位数分别为3800印度卢比和4000印度卢比。住宿的直接非医疗费用较高（中位数费用为800印度卢比），非结核病药物的直接医疗费用较高（中位数费用为2000印度卢比）。然而，诊断后期间，最高的直接医疗和非医疗费用分别归因于住院（1200印度卢比）和住宿费用（700印度卢比）。总体间接费用中位数为300印度卢比，诊断后期间最高总间接费用为40000印度卢比。约三分之一的患者面临收入损失，19.6%的患者面临应对费用。患者在结核病治疗上花费了约6.7%（0.97%-52.3%）的收入。约12.3%的患者面临灾难性支出。在诊断前期间，寻求私立医疗保健机构的患者的费用中位数显著更高（私立为12100印度卢比，公立为6800印度卢比；P<0.05）。所有三个中心的诊断前和诊断后的自付费用（OPE）均显著更高（P<0.05）。
结核病患者在项目环境中经历了不良支出。八分之一患者所面临的费用具有灾难性。
