How affordable is TB care? Findings from a nationwide TB patient cost survey in Ghana.

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2018
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Abstract
Tuberculosis (TB) is known as a disease of the poor. Despite TB diagnosis and care usually being offered for free, TB patients can still face substantial costs, especially in the context of multi-drug resistance (MDR). The End TB Strategy calls for zero TB-affected families incurring 'catastrophic' costs due to TB by 2025. This paper examines, by MDR status, the level and composition of costs incurred by TB-affected households during care seeking and treatment; assesses the affordability of TB care using catastrophic and impoverishment measures; and describes coping strategies used by TB-affected households to pay for TB care.A nationally representative survey of TB patients at public health facilities across Ghana.We enrolled 691 patients (66 MDR). The median expenditure for non-MDR TB was US$429.6 during treatment, vs. US$659.0 for MDR patients (P-value = 0.001). Catastrophic costs affected 64.1% of patients. MDR patients were pushed significantly further over the threshold for catastrophic payments than DS patients. Payments for TB care led to a significant increase in the proportion of households in the study sample that live below the poverty line at the time of survey compared to pre-TB diagnosis. Over half of patients undertook coping strategies.TB patients in Ghana incur substantial costs, despite free diagnosis and treatment. High rates of catastrophic costs and coping strategies in both non-MDR and MDR patients show that new policies are urgently needed to ensure TB care is actually affordable for TB patients.
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Authors Pedrazzoli, Debora;Siroka, Andrew;Boccia, Delia;Bonsu, Frank;Nartey, Kenneth;Houben, Rein;Borghi, Josephine;
Journal Tropical medicine & international health : TM & IH
Year 2018
DOI
10.1111/tmi.13085
URL
Keywords
ghana affordability coping strategies tb appauvrissement caractère abordable catastrophic costs coûts catastrophiques impoverishment stratégies d'adaptation

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