National Lung Hospital, Ha Noi, Viet Nam.
Friends for International TB Relief, Ha Noi, Viet Nam.
Infect Dis Poverty. 2024 Mar 25;13(1):27. doi: 10.1186/s40249-024-01196-2.
In Viet Nam, tuberculosis (TB) represents a devastating life-event with an exorbitant price tag, partly due to lost income from daily directly observed therapy in public sector care. Thus, persons with TB may seek care in the private sector for its flexibility, convenience, and privacy. Our study aimed to measure income changes, costs and catastrophic cost incurrence among TB-affected households in the public and private sector.
Between October 2020 and March 2022, we conducted 110 longitudinal patient cost interviews, among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program (NTP) in Ha Noi, Hai Phong and Ho Chi Minh City, Viet Nam. Using a local adaptation of the WHO TB patient cost survey tool, participants were interviewed during the intensive phase, continuation phase and post-treatment. We compared income levels, direct and indirect treatment costs, catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate regression.
The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort (USD 868 vs USD 578; P = 0.010). However, private sector treatment was also significantly costlier (USD 2075 vs USD 1313; P = 0.005), driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants (USD 754 vs USD 164; P < 0.001). This resulted in no significant difference in catastrophic costs between the two cohorts (Private: 55% vs NTP: 52%; P = 0.675). Factors associated with catastrophic cost included being a single-person household [adjusted odds ratio (aOR = 13.71; 95% confidence interval (CI): 1.36-138.14; P = 0.026], unemployment during treatment (aOR = 10.86; 95% CI: 2.64-44.60; P < 0.001) and experiencing TB-related stigma (aOR = 37.90; 95% CI: 1.72-831.73; P = 0.021).
Persons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the public or private sector. Patient costs could be reduced through expanded insurance reimbursement to minimize direct medical costs in the private sector, use of remote monitoring and multi-week/month dosing strategies to avert economic costs in the public sector and greater access to social protection mechanism in general.
在越南，结核病（TB）是一种毁灭性的生命事件，其代价高昂，部分原因是在公共部门接受每日直接观察治疗而导致收入损失。因此，结核病患者可能会选择在私营部门接受治疗，因为私营部门具有灵活性、便利性和隐私性。我们的研究旨在衡量受结核病影响的家庭在公共和私营部门的收入变化、成本和灾难性支出。
在 2020 年 10 月至 2022 年 3 月期间，我们对 50 名在私营部门接受结核病治疗的患者和 60 名在河内、海防和胡志明市接受国家结核病规划（NTP）治疗的结核病患者进行了 110 次纵向患者成本访谈。我们使用世界卫生组织结核病患者成本调查工具的本地改编版，在强化期、延续期和治疗后对参与者进行访谈。我们使用 Wilcoxon 秩和检验和卡方检验比较了两组的收入水平、直接和间接治疗成本以及灾难性成本，并使用多变量回归分析了两组之间的相关危险因素。
私营部门治疗前的家庭月中位数收入明显高于 NTP 队列（868 美元对 578 美元；P=0.010）。然而，私营部门治疗的费用也明显更高（2075 美元对 1313 美元；P=0.005），这主要是由于直接医疗费用比 NTP 参与者报告的费用高 4.6 倍（754 美元对 164 美元；P<0.001）。这导致两组的灾难性成本没有显著差异（私营部门：55%对 NTP：52%；P=0.675）。与灾难性成本相关的因素包括单身家庭[调整后的优势比（aOR=13.71；95%置信区间（CI）：1.36-138.14；P=0.026]、治疗期间失业（aOR=10.86；95%CI：2.64-44.60；P<0.001）和结核病相关耻辱感（aOR=37.90；95%CI：1.72-831.73；P=0.021）。
在越南，无论在公共部门还是私营部门接受治疗，结核病患者都面临着同样高的灾难性支出风险。通过扩大保险报销范围来降低患者费用，从而最大限度地减少私营部门的直接医疗费用，使用远程监测和多周/月剂量策略来避免公共部门的经济成本，并普遍增加获得社会保护机制的机会，可以降低患者费用。
