Research, George Institute for Global Health, 308, Elegance Tower, Plot No 8, Jasola District Centre, New Delhi 110025, India.
Faculty of Medicine, University of New South Wales, High St, Kensington, NSW 2052, Australia.
Health Policy Plan. 2024 Sep 10;39(8):854-863. doi: 10.1093/heapol/czae065.
Providing social support to tuberculosis (TB) patients is a recommended strategy as households having TB patients find themselves in a spiral of poverty because of high cost, huge income loss and several other economic consequences associated with TB treatment. However, there are few examples of social support globally. The Indian government introduced the 'Nikshay Poshan Yojana' scheme in 2018 to provide nutritional support for all registered TB patients. A financial incentive of 500 Indian Rupee (6 United States Dollars) per month was proposed to be transferred directly to the registered beneficiaries' validated bank accounts. We examined the reach, timing, amount of benefit receipt and the extent to which the benefit alleviated catastrophic costs (used as a proxy to measure the impact on permanent economic welfare as catastrophic cost is the level of cost that is likely to result in a permanent negative economic impact on households) by interviewing 1482 adult drug-susceptible TB patients from 16 districts of four states during 2019 to 2023, using the methods recommended by the World Health Organization for estimating household costs of TB nationally. We also estimated the potential amount of social support required to achieve a zero catastrophic cost target. At the end of treatment, 31-54% of study participants received the benefit. In all, 34-60% of TB patients experienced catastrophic costs using different estimation methods and the benefit helped 2% of study participants to remain below the catastrophic cost threshold. A uniform benefit amount of Indian Rupee 10 000 (127 United States Dollars) for 6 months of treatment could reduce the incidence of catastrophic costs by 43%. To improve the economic welfare of TB patients, levels of benefit need to be substantially increased, which will have considerable budgetary impact on the TB programme. Hence, a targeted rather than universal approach may be considered. To maximize impact, at least half of the revised amount should be given immediately after treatment registration.
为结核病（TB）患者提供社会支持是一种推荐的策略，因为有 TB 患者的家庭会因治疗 TB 的高昂费用、巨大的收入损失和其他一些经济后果而陷入贫困的恶性循环。然而，全球范围内很少有社会支持的例子。印度政府于 2018 年推出了“Nikshay Poshan Yojana”计划，为所有登记的 TB 患者提供营养支持。建议每月向登记的受益人直接转入 500 印度卢比（6 美元）的财政激励。我们通过采访 2019 年至 2023 年期间来自四个邦的 16 个区的 1482 名成年耐药性结核病患者，检查了覆盖范围、时间、受益金额以及受益在多大程度上减轻了灾难性费用（用作衡量对永久经济福利影响的代理，因为灾难性费用是可能对家庭造成永久负面经济影响的费用水平），使用世界卫生组织为全国范围内估算结核病家庭费用而推荐的方法。我们还估计了实现零灾难性费用目标所需的社会支持的潜在金额。在治疗结束时，31-54%的研究参与者获得了这项福利。总之，使用不同的估算方法，34-60%的结核病患者经历了灾难性费用，而这项福利帮助了 2%的研究参与者保持在灾难性费用阈值以下。统一的 10000 印度卢比（127 美元）的 6 个月治疗津贴可以将灾难性费用的发生率降低 43%。为了提高结核病患者的经济福利，需要大幅提高福利水平，这将对结核病规划产生相当大的预算影响。因此，可以考虑采取有针对性而不是普遍的方法。为了最大限度地发挥影响，至少应在治疗登记后立即发放一半以上的修订金额。
