National TB Programme, Ministry of Health, Vientiane, Lao PDR.
Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland.
PLoS One. 2020 Nov 12;15(11):e0241862. doi: 10.1371/journal.pone.0241862. eCollection 2020.
Tuberculosis (TB) patients incur large costs for care seeking, diagnosis, and treatment. To understand the magnitude of this financial burden and its main cost drivers, the Lao People's Democratic Republic (PDR) National TB Programme carried out the first national TB patient cost survey in 2018-2019.
A facility-based cross-sectional survey was conducted based on a nationally representative sample of TB patients from public health facilities across 12 provinces. A total of 848 TB patients including 30 drug resistant (DR)-TB and 123 TB-HIV coinfected patients were interviewed using a standardised questionnaire developed by the World Health Organization. Information on direct medical, direct non-medical and indirect costs, as well as coping mechanisms was collected. We estimated the percentage of TB-affected households facing catastrophic costs, which was defined as total TB-related costs accounting for more than 20% of annual household income.
The median total cost of TB care was US$ 755 (Interquartile range 351-1,454). The costs were driven by direct non-medical costs (46.6%) and income loss (37.6%). Nutritional supplements accounted for 74.7% of direct non-medical costs. Half of the patients used savings, borrowed money or sold household assets to cope with TB. The proportion of unemployment more than doubled from 16.8% to 35.4% during the TB episode, especially among those working in the informal sector. Of all participants, 62.6% of TB-affected households faced catastrophic costs. This proportion was higher among households with DR-TB (86.7%) and TB-HIV coinfected patients (81.1%).
In Lao PDR, TB patients and their households faced a substantial financial burden due to TB, despite the availability of free TB services in public health facilities. As direct non-medical and indirect costs were major cost drivers, providing free TB services is not enough to ease this financial burden. Expansion of existing social protection schemes to accommodate the needs of TB patients is necessary.
结核病（TB）患者在寻求医疗、诊断和治疗方面会产生大量费用。为了了解这种经济负担的规模及其主要成本驱动因素，老挝人民民主共和国（PDR）国家结核病规划于 2018-2019 年进行了首次全国结核病患者费用调查。
基于来自 12 个省份公共卫生机构的全国代表性结核病患者样本，进行了一项基于机构的横断面调查。对 848 名结核病患者（包括 30 名耐多药（DR）-结核病和 123 名结核病-艾滋病毒合并感染患者）进行了访谈，使用世界卫生组织制定的标准化问卷。收集了直接医疗、直接非医疗和间接费用以及应对机制的信息。我们估计了面临灾难性费用的结核病患者家庭的百分比，这被定义为结核病相关费用占家庭年收入的 20%以上。
结核病护理的总费用中位数为 755 美元（四分位距 351-1454）。费用由直接非医疗费用（46.6%）和收入损失（37.6%）驱动。营养补充剂占直接非医疗费用的 74.7%。一半的患者使用储蓄、借款或出售家庭资产来应对结核病。在结核病发作期间，失业比例从 16.8%增加到 35.4%，尤其是在从事非正规部门工作的人群中。所有参与者中，62.6%的结核病患者家庭面临灾难性费用。耐多药结核病（86.7%）和结核病-艾滋病毒合并感染患者（81.1%）家庭面临灾难性费用的比例更高。
在老挝 PDR，尽管公共卫生机构提供免费结核病服务，但结核病患者及其家庭仍面临巨大的经济负担。由于直接非医疗和间接费用是主要成本驱动因素，提供免费结核病服务不足以减轻这种经济负担。有必要扩大现有的社会保护计划，以满足结核病患者的需求。
