Health Services Academy, Opposite National Institute of Health (NIH), Islamabad, Pakistan.
Aga Khan University, Community Health Sciences Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
Glob Health Res Policy. 2022 Jul 21;7(1):22. doi: 10.1186/s41256-022-00259-x.
Despite free tuberculosis (TB) care in Pakistan, patients still have to bear high costs, which push them into poverty. This study estimated the pre- and post-diagnosis costs households bear for TB care, and investigated coping mechanisms among adults ≥ 18 years in Karachi, Pakistan.
We conducted a cross-sectional study comprising of 516 TB patients identified with completion of at least one month intensive treatment from four public sector health facilities from two institutes in Karachi, Pakistan. A standardized questionnaire to estimate patient's costs was administered. The study outcomes were direct medical and non-medical costs, and indirect costs. The costs were estimated during pre-diagnostic and post-diagnostic phase which includes diagnostic, treatment, and hospitalization phases. A descriptive analysis including mean and standard deviation (± SD), median and interquartile range (IQR), and frequencies and proportions (%) was employed.
Out of 516 TB patients, 52.1% were female with a mean age of 32.4 (± 13.7) years. The median costs per patient during the pre-diagnostic, diagnostic, treatment and hospitalization periods were estimated at USD63.8/ PKR7,377, USD24/ PKR2,755, USD10.5/ PKR1,217, and USD349.0/ PKR40,300, respectively. The total household median cost was estimated at USD129.2/ PKR14,919 per patient. The median indirect cost was estimated at USD52.0/ PKR5,950 per patient. Of total, 54.1% of patients preferred and consulted private providers in the first place at the onset of symptoms, while, 36% attended public healthcare services, 5% and 4.1% went to dispensary and pharmacy, respectively, as a first point of care.
TB patients bear substantial out-of-pocket costs before they are enrolled in publically funded TB programs. There should be provision of transport and food vouchers, also health insurance for in-patient treatment. This advocates a critical investigation into an existing financial support network for TB patients in Pakistan towards reducing the burden.
尽管巴基斯坦提供免费的肺结核（TB）治疗，但患者仍需承担高昂的费用，这使他们陷入贫困。本研究旨在评估巴基斯坦卡拉奇地区≥18 岁成年人在结核病诊断前后的家庭负担，并调查他们的应对机制。
我们进行了一项横断面研究，共纳入了 516 名在卡拉奇的两家研究所的四家公立卫生机构完成至少一个月强化治疗的 TB 患者。使用标准化问卷来评估患者的费用。研究结果为直接医疗和非医疗费用以及间接费用。这些费用在诊断前和诊断后阶段进行估算，包括诊断、治疗和住院阶段。采用描述性分析，包括均值和标准差（±SD）、中位数和四分位距（IQR）、频率和比例（%）。
在 516 名 TB 患者中，52.1%为女性，平均年龄为 32.4（±13.7）岁。在诊断前、诊断、治疗和住院期间，每位患者的中位费用分别估计为 63.8 美元/7377 巴基斯坦卢比、24 美元/2755 巴基斯坦卢比、10.5 美元/1217 巴基斯坦卢比和 349.0 美元/40300 巴基斯坦卢比。每位患者的家庭总中位费用估计为 129.2 美元/14919 巴基斯坦卢比。中位间接费用估计为每位患者 52.0 美元/5950 巴基斯坦卢比。在症状出现时，54.1%的患者首选并首先咨询私人提供者，36%的患者就诊于公共医疗服务机构，5%和 4.1%的患者分别前往诊所和药店作为第一治疗点。
在纳入公共资助的结核病项目之前，结核病患者需要承担大量的自付费用。应提供交通和食品券，以及住院治疗的医疗保险。这就需要对巴基斯坦现有的结核病患者财务支持网络进行深入调查，以减轻负担。
