Pre- and post-diagnosis costs of tuberculosis to patients on Directly
Observed Treatment Short course in districts of southwestern Ethiopia:
a longitudinal study
Background: Financial burden on tuberculosis (TB) patients results in
delayed treatment and poor compliance. We assessed pre- and
post-diagnosis costs to TB patients. Methods: A longitudinal study
among 735 new TB cases was conducted from January 2015 through June
2016 in 10 woredas (districts) of southwestern Ethiopia. Direct
out-of-pocket, payments, and lost income (indirect cost) were solicited
from patients during the first 2 months and at the end of treatment.
Thus, we ascertained direct medical, nonmedical, and indirect costs
incurred by patients during pre- and post-diagnosis periods. We
categorized costs incurred from onset of illness until TB diagnosis as
pre-diagnosis and that incurred after diagnosis through treatment
completion as post-diagnosis. Pre- and post-diagnosis costs constitute
total cost incurred by the patients. We fitted linear regression model
to identify predictors of cost. Results: Between onset of illness and
anti-TB treatment course, patients incurred a median (inter-quartile
range (IQR)) of US201.48(136.72˘013318.94).Ofthetotalcost,theindirectanddirectcostsrespectivelyconstituted70.6and29.4patientsincurredamedian(IQR)ofUS97.62 (6.43\u2013184.22) and
US93.75(56.912˘013141.54)duringthepre−andpost−diagnosisperiods,respectively.Thus,patientsincurred53.6duringthepre−diagnosisperiod.Directout−of−pocketexpensesduringthepre−andpost−diagnosisperiodsrespectivelyamounttomedian(IQR)ofUS21.64 (10.23\u201348.31) and US$35.02 (0\u201370.04). Patient
delay days (p < 0.001), provider delay days (p < 0.001), number
of healthcare facilities visited until TB diagnosis (p < 0.001), and
TB diagnosis at private facilities (p = 0.02) independently predicted
increased pre-diagnosis cost. Similarly, rural residence (p <
0.001), hospitalization during anti-TB treatment (p < 0.001),
patient delay days (p < 0.001), and provider delay days (p <
0.001) predicted increased post-diagnosis costs. Conclusion: TB
patients incur substantial cost for care seeking and treatment despite
\u201cfree service\u201d for TB. Therefore, promoting early care
seeking, decentralizing efficient diagnosis, and treatment services
within reach of peoples, and introducing reimbursement system for
direct costs can help minimize financial burden to the patient