D'Silva Olivia Alise, Lancione Samantha, Ananthakrishnan Oviya, Addae Angelina, Shrestha Suvesh, Alsdurf Hannah, Thavorn Kednapa, Mzizi Nompumelelo, Vasilu Anca, Kay Alexander, Mandalakas Anna Maria, Zwerling Alice Anne
University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada.
Department of Microbiology and Immunology, University of Western Ontario, London, Canada.
PLOS Glob Public Health. 2025 Apr 2;5(4):e0004283. doi: 10.1371/journal.pgph.0004283. eCollection 2025.
Eliminating the burden of catastrophic costs experienced by individuals undergoing tuberculosis (TB) treatment is one of the World Health Organization (WHO) End TB Strategy targets. To help inform decisions on TB patient burden and cost-effective TB care, we conducted a systematic review to summarize current evidence around the burden of catastrophic costs incurred by individuals undergoing TB treatment and identified the main drivers of costs to aid in developing mitigation strategies. A literature search was performed in August 2024 using Embase, Web of Science, Scopus and Medline targeting studies using WHO, or WHO adapted patient costing questionnaires to measure direct (medical and non-medical) and indirect costs associated with TB care. Key cost data and patient baseline characteristics were extracted. The study protocol was registered in PROSPERO (Registration number: CRD42021293600). The systematic review included 76 studies; with 70% published over the last 5 years. Total mean costs per person for TB care ranged from $7.13 - $11,329 USD; pre-diagnostic costs ranged from $30.37 - $1,442 USD; and post-diagnostic costs ranged from $33.64 - $5,194 USD. Costs were consistently higher amongst persons with drug resistant TB (DR-TB) and those identified through passive case finding (PCF). Hospitalization and loss of income were the largest drivers of cost. Despite many countries offering free TB treatment, patients still incurred significant catastrophic costs. Our review suggests that active case finding, improving access to DR-TB testing, and adopting social protection interventions may help mitigate the burden of out-of-pocket expenditures incurred by people suffering with TB.
消除结核病治疗患者所经历的灾难性费用负担是世界卫生组织（WHO）终止结核病战略目标之一。为了为有关结核病患者负担和具有成本效益的结核病护理的决策提供信息，我们进行了一项系统综述，以总结目前关于结核病治疗患者所产生的灾难性费用负担的证据，并确定成本的主要驱动因素，以帮助制定缓解策略。2024年8月，我们使用Embase、Web of Science、Scopus和Medline进行了文献检索，目标是使用WHO或WHO改编的患者成本计算问卷来衡量与结核病护理相关的直接（医疗和非医疗）和间接成本的研究。提取了关键成本数据和患者基线特征。该研究方案已在PROSPERO注册（注册号：CRD42021293600）。该系统综述包括76项研究；其中70%是在过去5年发表的。结核病护理的人均总平均成本从7.13美元到11329美元不等；诊断前成本从30.37美元到1442美元不等；诊断后成本从33.64美元到5194美元不等。耐多药结核病（DR-TB）患者和通过被动病例发现（PCF）确诊的患者的成本一直较高。住院和收入损失是最大的成本驱动因素。尽管许多国家提供免费的结核病治疗，但患者仍然产生了大量灾难性费用。我们的综述表明，主动病例发现、改善耐多药结核病检测的可及性以及采取社会保护干预措施可能有助于减轻结核病患者自付费用的负担。
