Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India.
Indian J Tuberc. 2024;71 Suppl 2:S229-S236. doi: 10.1016/j.ijtb.2024.01.007. Epub 2024 Jan 5.
India shares a significant proportion of the Tuberculosis (TB) burden of the world. TB diagnosis, treatment, and success are complicated by the chronic nature of the disease as well as additional stressors including financial, psychological, and social hardships, adverse events associated with management, and poor compliance towards anti-tuberculosis medications.
This is a longitudinal study conducted in the Tuberculosis Units (TUs) of rural field practice areas of the Department of Community Medicine and Family Medicine in a tertiary care hospital in Odisha. 168 diagnosed TB patients from the TUs were enrolled after registration in NTEP and were followed up every month for 6 months or treatment completion. TB patient's cost estimate tool was used to collect data regarding the cost incurred by the patients before and during the diagnosis as well as in the post-diagnosis or treatment period.
Out-of-pocket expenditure was calculated as direct, indirect, and total cost in the pre and post-diagnostic phases of the disease. The median pre and post-diagnosis direct, indirect and total costs were ₹ 12,805, ₹ 16,960 and ₹ 31,192, respectively, with almost 62 % of participants spending more than 20 % of their annual income. In this study, 41 % of participants had to stop working for more than 60 days, and 53.1 % faced distress financing due to the disease. Through this study, we found that more than half of rural TB patients still visit private health facilities, and 20 % start anti-TB drugs by purchasing them from private pharmacies, which incur substantial out-of-pocket expenditure. Most participants faced catastrophic costs associated with hospitalisation, lower family income, and a delay in disease diagnosis.
印度在全球结核病（TB）负担中占有相当大的比例。由于疾病的慢性性质以及包括财务、心理和社会困难、与管理相关的不良事件以及对抗结核药物的依从性差等额外压力，TB 的诊断、治疗和成功变得复杂。
这是一项在印度奥里萨邦一家三级保健医院社区医学和家庭医学部门农村实地实践区的结核病单位（TUs）进行的纵向研究。在国家结核病规划登记后，从 TUs 招募了 168 名确诊的 TB 患者，并在接下来的 6 个月或治疗完成期间每月进行随访。使用 TB 患者费用估算工具收集患者在诊断前和诊断期间以及诊断后或治疗期间产生的费用数据。
在疾病的诊断前和诊断后阶段，计算了自付费用，包括直接、间接和总费用。直接、间接和总费用的中位数分别为₹12805、₹16960 和₹31192，约 62%的参与者花费了超过其年收入的 20%。在这项研究中，41%的参与者因疾病不得不停止工作超过 60 天，53.1%的参与者因疾病而面临困扰性融资。通过这项研究，我们发现，超过一半的农村 TB 患者仍然去私人医疗机构就诊，20%的患者开始从私人药店购买抗 TB 药物，这导致了大量的自付费用。大多数参与者面临与住院相关的灾难性费用、家庭收入较低以及疾病诊断延迟。
