Estimating Catastrophic Costs due to Pulmonary Tuberculosis in Bangladesh

作者：Anita Sharif Chowdhury, Md. Shakil Ahmed, Sayem Ahmed, Fouzia Khanam, Fariha Farjana, Saifur Reza, Shayla Islam, Akramul Islam, Jahangir Khan, Mahfuzar Rahman · 发表于：Journal of Epidemiology and Global Health · 年份：2020 · DOI：10.2991/jegh.k.200530.001 · 被引用次数：17 · 研究领域：Healthcare Systems and Reforms、Global Health and Epidemiology、Global Maternal and Child Health

To eliminate TB from the country by the year 2030, the Bangladesh National Tuberculosis (TB) Program is providing free treatment to the TB patients since 1993. However, the patients are still to make Out-of-their Pocket (OOP) payment, particularly before their enrollment Directly Observed Treatment Short-course (DOTS). This places a significant economic burden on poor-households. We, therefore, aimed to estimate the Catastrophic Health Expenditure (CHE) due to TB as well as understand associated difficulties faced by the families when a productive family member age (15-55) suffers from TB. The majority of the OOP expenditures occur before enrolling in. We conducted a cross-sectional study using multistage sampling in the areas of Bangladesh where Building Resources Across Communities (BRAC) provided TB treatment during June 2016. In total, 900 new TB patients, aged 15-55 years, were randomly selected from a list collected from BRAC program. CHE was defined as the OOP payments that exceeded 10% of total consumption expenditure of the family and 40% of total non-food expenditure/capacity-to-pay. Regular and Bayesian simulation techniques with 10,000 replications of re-sampling with replacement were used to examine robustness of the study findings. We also used linear regression and logit model to identify the drivers of OOP payments and CHE, respectively. The average total cost-of-illness per patient was 124 US$, of which 68% was indirect cost. The average CHE was 4.3% of the t...