Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
Regional Director of Health Services, Kalutara District, Sri Lanka.
Indian J Tuberc. 2023 Jul;70(3):315-318. doi: 10.1016/j.ijtb.2022.06.003. Epub 2022 Jun 15.
Tuberculosis (TB) is a communicable disease. Financial risk protection is a key target to achieve in end TB strategy. Out-Of-Pocket Expenditure (OOPE) consisted of expenses bore by patients for their illnesses after subtracting third-party payments such as insurance. Despite the free health care in Sri Lanka, TB patients have to pay for various expenses (e.g., expenses for travel, food, drugs, medical investigations, and cost of accompanied person/bystander).
The main objective of this study was to estimate direct OOPE and find the association between direct OOPE and noncompliance to TB treatment in intensive phase.
A cross-sectional study was conducted with TB patients who were registered in Kalutara-district chest clinic for period of six months (n = 267). Interviewer-administered questionnaire (consisted of sections on socio-demographic characteristics, treatment compliance, sources and amount of OOPE, etc.) was used to collect data. Mean median, minimum, maximum and interquartile range were calculated in each component of OOPE.
Questionnaire were administered for 252 patients (male = 160, 63.5%). Mean total direct non-medical cost for one DOTS visit (without accompanied person) was 435.40 (IQR = 420.00) Sri Lankan Rupees (SLR) (i.e., 2.45 United State Dollars (USD)). A patient without an accompanying person spent 26124.00 SLR (435.40 per day into 60 days) (i.e., 146.76 USD) for transport and food during the intensive phase. During the intensive phase, the mean medical cost for one patient was 6444.66 LKR (IQR = 6400) (i.e., 36.21 USD). OOPE was not associated with noncompliance to TB treatment in intensive phase (p = 0.29).
There was no association between OOPE and noncompliance. The direct OOPE for TB treatment in the intensive phase was high. Therefore, it is necessary to develop strategies to reduce OOPE during TB treatment especially in intensive phase.
结核病（TB）是一种传染性疾病。财务风险保护是终结结核病策略的关键目标之一。自付费用（OOPE）是指患者在扣除第三方付款（如保险）后为其疾病支付的费用。尽管斯里兰卡提供免费医疗，但结核病患者仍需支付各种费用（例如旅行、食物、药品、医疗检查和陪伴者/旁观者的费用）。
本研究的主要目的是估计直接自付费用，并发现直接自付费用与强化期治疗不依从之间的关系。
对在卡拉图地区胸科诊所登记的结核病患者进行了为期六个月的横断面研究（n=267）。使用访谈者管理的问卷（包括社会人口学特征、治疗依从性、自付费用的来源和金额等部分）收集数据。在每个自付费用组成部分中计算平均值、中位数、最小值、最大值和四分位距。
共对 252 名患者（男性=160，63.5%）进行了问卷调查。一次 DOTS 就诊（无陪伴者）的总直接非医疗费用平均为 435.40 斯里兰卡卢比（IQR=420.00）（即 2.45 美元）。没有陪伴者的患者在强化期内用于交通和食物的费用为 26124.00 斯里兰卡卢比（435.40 每天×60 天）（即 146.76 美元）。在强化期内，每位患者的平均医疗费用为 6444.66 斯里兰卡卢比（IQR=6400）（即 36.21 美元）。自付费用与强化期治疗不依从之间无关联（p=0.29）。
自付费用与不依从之间没有关联。强化期结核病治疗的直接自付费用较高。因此，有必要制定策略来减少结核病治疗期间的自付费用，尤其是在强化期。
