1Center for International Health, University of Otago, Dunedin, New Zealand.
2Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
Am J Trop Med Hyg. 2020 Sep;103(3):1057-1064. doi: 10.4269/ajtmh.19-0848.
Costs related to tuberculosis (TB) can impose a significant burden on patients and their families and create barriers to diagnosis and treatment. Our study aimed to quantify out-of-pocket costs expended by TB patients in Bandung, Indonesia. This cross-sectional study recruited adults with TB from community health centers (CHCs), public and private hospitals, and private practitioners (PPs). An interview was completed at the time of diagnosis or at their return for 2- or 6-month treatment. Costs were converted to U.S. dollars (US$)-presented as median and interquartile range (IQR). Of 469 TB patients recruited, the mean age was 38 years and 57% were male. The median pretreatment direct cost per person was $37.51 (IQR 20.79-71.24). Hospitalization, diagnostic tests, and travel costs were predominant. Higher pretreatment costs were associated with no health insurance ($41.88 versus $27.41, < 0.001), ≥ 6 visits to a healthcare provider ($39.91 versus $24.32, < 0.001), ≥ 60 days pretreatment ($36.35 versus $26.25, = 0.02), and presenting first to a PP ($40.71) or informal provider ($32.72) compared with private hospital ($21.26), public hospital ($19.63), or CHC ($13.52) ( = 0.01). For a subsample of 106 patients with total pre- and posttreatment costs available, the median total cost was $243.66 (IQR 128.46-550.71). For 26.5% of these patients, total costs were ≥ 20% of their annual household income. Despite having a good network of free TB diagnostic and treatment services throughout Bandung, patients experienced significant out-of-pocket costs. Increased uptake of the National Health Insurance, and systems for early recognition and diagnosis of TB, will contribute toward reducing costs.
在印度尼西亚万隆，结核病（TB）相关费用可能给患者及其家庭带来沉重负担，并成为诊断和治疗的障碍。本研究旨在量化万隆的结核病患者的自付费用。这项横断面研究招募了来自社区卫生中心（CHC）、公立和私立医院以及私人从业者（PP）的成年结核病患者。在诊断时或在接受 2 或 6 个月治疗后进行访谈。费用转换为美元（US$）-以中位数和四分位距（IQR）表示。在招募的 469 名结核病患者中，平均年龄为 38 岁，57%为男性。每人治疗前的直接费用中位数为 37.51 美元（IQR 20.79-71.24）。住院、诊断测试和旅行费用占主导地位。较高的治疗前费用与无健康保险（$41.88 与 $27.41，<0.001）、就诊次数≥6 次（$39.91 与 $24.32，<0.001）、治疗前≥60 天（$36.35 与 $26.25，=0.02）以及首次就诊于私人从业者（$40.71）或非正规提供者（$32.72）而非私立医院（$21.26）、公立医院（$19.63）或 CHC（$13.52）有关（=0.01）。对于 106 名可提供总治疗前和治疗后费用的患者亚组，中位总费用为 243.66 美元（IQR 128.46-550.71）。对于其中 26.5%的患者，总费用占其家庭年收入的≥20%。尽管万隆拥有良好的免费结核病诊断和治疗服务网络，但患者仍面临大量自付费用。增加对国家健康保险的利用，并建立早期识别和诊断结核病的系统，将有助于降低费用。
