Yamanaka T, Garfin A M C, Gaviola D M G, Arao R M, Morishita F, Hiatt T, Nishikiori N, Yadav R P
World Health Organization (WHO), Global Tuberculosis Programme, Geneva, Switzerland.
Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
Public Health Action. 2023 Jun 21;13(2):53-59. doi: 10.5588/pha.23.0014.
This study was to meet a practical need to design a simple tool to identify TB patients who may potentially be facing catastrophic costs while seeking TB care in the public sector. Such a tool may help prevent and address catastrophic costs among individual patients.
We used data from the national TB patient cost survey in the Philippines. We randomly allocated TB patients to either the derivation or validation sample. Using adjusted odds ratios (ORs) and β coefficients of logistic regression, we developed four scoring systems to identify TB patients who may be facing catastrophic costs from the derivation sample. We validated each scoring system in the validation sample.
We identified a total of 12 factors as predictive indicators associated with catastrophic costs. Using all 12 factors, the β coefficients-based scoring system (area under the curve [AUC] 0.783, 95% CI 0.754-0.812) had a high validity. Even with seven selected factors with OR > 2.0, the validity remained in the acceptable range (β coefficients-based: AUC 0.767, 95% CI 0.737-0.798).
The β coefficients-based scoring systems in this analysis can be used to identify those at high risk of facing catastrophic costs due to TB in the Philippines. Operational feasibility needs to be investigated further to implement this in routine TB surveillance.
本研究旨在满足一项实际需求，即设计一种简单工具，以识别在公共部门寻求结核病治疗时可能面临灾难性费用的结核病患者。这样一种工具可能有助于预防和解决个体患者的灾难性费用问题。
我们使用了菲律宾全国结核病患者费用调查的数据。我们将结核病患者随机分配到推导样本或验证样本中。利用调整后的比值比（OR）和逻辑回归的β系数，我们从推导样本中开发了四个评分系统，以识别可能面临灾难性费用的结核病患者。我们在验证样本中对每个评分系统进行了验证。
我们共确定了12个与灾难性费用相关的预测指标。使用所有12个因素，基于β系数的评分系统（曲线下面积[AUC]为0.783，95%可信区间为0.754 - 0.812）具有较高的有效性。即使使用7个OR > 2.0的选定因素，有效性仍处于可接受范围内（基于β系数的：AUC为0.767，95%可信区间为0.737 - 0.798）。
本分析中基于β系数的评分系统可用于识别菲律宾因结核病而面临灾难性费用高风险的人群。在结核病常规监测中实施这一系统的操作可行性需要进一步研究。
