The economic burden of households affected by tuberculosis in Brazil: First national survey results, 2019-2021
One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a base...
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| Veröffentlicht in: | PloS one 2023-12, Vol.18 (12), p.e0287961-e0287961 |
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| creator | Noia Maciel, Ethel Leonor Negri, Letícya Dos Santos Almeida Guidoni, Leticia Molino Fregona, Geisa Carlesso Johansen, Fernanda Dockhorn Costa Sanchez, Mauro Niskier Moreira, Adriana da Silva Rezende Diaz-Quijano, Fredi Alexander Tonini, Maiko Zandonade, Eliana Ershova, Julia Nguhiu, Peter Baena, Inés Garcia |
| description | One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a baseline, the magnitude and main drivers of the costs associated with TB disease for patients and their households and to monitor the proportion of households experiencing catastrophic costs in Brazil.
A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors ( |
| doi_str_mv | 10.1371/journal.pone.0287961 |
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A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors (<18 years old) were interviewed once about costs, time loss, coping measures, income, household expenses, and asset ownership. Total costs, including indirect costs measured as reported household income change, were expressed as a percentage of annual household income. We used descriptive statistics to analyze the cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs.
We interviewed 603 patients, including 538 (89%) with drug-sensitive (DS) and 65 (11%) with drug-resistant (DR) TB. Of 603 affected households, 48.1% (95%CI: 43-53.2) experienced costs above 20% of their annual household income during their TB episode. The proportion was 44.4% and 78.5% among patients with DS- and DR-TB, respectively. On average, patients incurred costs of US$1573 (95%CI: 1361.8-1785.0) per TB episode, including pre-diagnosis and post-diagnosis expenses. Key cost drivers were post-diagnosis nutritional supplements (US$317.6, 95%CI: 232.7-402.6) followed by medical costs (US$85.5, 95%CI: 54.3-116.5) and costs of travel for clinic visits during treatment (US$79.2, 95%CI: 61.9-96.5). In multivariate analysis, predictors of catastrophic costs included positive HIV status (aOR = 3.0, 95%CI:1.1-8.6) and self-employment (aOR = 2.7, 95%CI:1.1-6.5); high education was a protective factor (aOR = 0.1, 95%CI:0.0-0.9).
Although the services offered to patients with TB are free of charge in the Brazilian public health sector, the availability of free diagnosis and treatment services does not alleviate patients' financial burden related to accessing TB care. The study allowed us to identify the costs incurred by patients and suggest actions to mitigate their suffering. In addition, this study established a baseline for monitoring catastrophic costs and fostering a national policy to reduce the costs to patients for TB care in Brazil.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0287961</identifier><identifier>PMID: 38091306</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Brazil - epidemiology ; Care and treatment ; Cost analysis ; Costs ; Costs and Cost Analysis ; COVID-19 ; Cross-Sectional Studies ; Data collection ; Diagnosis ; Dietary supplements ; Drug resistance ; Evaluation ; Expenditures ; Family income ; Financial Stress ; GDP ; Gross Domestic Product ; Handbooks ; Health facilities ; Health services ; Households ; Humans ; Income ; Medical care, Cost of ; Multivariate analysis ; Pandemics ; Patients ; Public health ; Sample size ; Statistical analysis ; Surveys ; Tuberculosis ; Tuberculosis - epidemiology ; Tuberculosis, Multidrug-Resistant</subject><ispartof>PloS one, 2023-12, Vol.18 (12), p.e0287961-e0287961</ispartof><rights>Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.</rights><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication: https://creativecommons.org/publicdomain/zero/1.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication: https://creativecommons.org/publicdomain/zero/1.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c693t-38145e569b59ceb3fdf751c31d5680a75d29c755de4830e7be044cc3b4c6caf43</citedby><cites>FETCH-LOGICAL-c693t-38145e569b59ceb3fdf751c31d5680a75d29c755de4830e7be044cc3b4c6caf43</cites><orcidid>0000-0002-0056-4506 ; 0000-0003-3737-5407 ; 0000-0003-4826-3355</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10718450/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10718450/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38091306$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Noia Maciel, Ethel Leonor</creatorcontrib><creatorcontrib>Negri, Letícya Dos Santos Almeida</creatorcontrib><creatorcontrib>Guidoni, Leticia Molino</creatorcontrib><creatorcontrib>Fregona, Geisa Carlesso</creatorcontrib><creatorcontrib>Johansen, Fernanda Dockhorn Costa</creatorcontrib><creatorcontrib>Sanchez, Mauro Niskier</creatorcontrib><creatorcontrib>Moreira, Adriana da Silva Rezende</creatorcontrib><creatorcontrib>Diaz-Quijano, Fredi Alexander</creatorcontrib><creatorcontrib>Tonini, Maiko</creatorcontrib><creatorcontrib>Zandonade, Eliana</creatorcontrib><creatorcontrib>Ershova, Julia</creatorcontrib><creatorcontrib>Nguhiu, Peter</creatorcontrib><creatorcontrib>Baena, Inés Garcia</creatorcontrib><title>The economic burden of households affected by tuberculosis in Brazil: First national survey results, 2019-2021</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a baseline, the magnitude and main drivers of the costs associated with TB disease for patients and their households and to monitor the proportion of households experiencing catastrophic costs in Brazil.
A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors (<18 years old) were interviewed once about costs, time loss, coping measures, income, household expenses, and asset ownership. Total costs, including indirect costs measured as reported household income change, were expressed as a percentage of annual household income. We used descriptive statistics to analyze the cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs.
We interviewed 603 patients, including 538 (89%) with drug-sensitive (DS) and 65 (11%) with drug-resistant (DR) TB. Of 603 affected households, 48.1% (95%CI: 43-53.2) experienced costs above 20% of their annual household income during their TB episode. The proportion was 44.4% and 78.5% among patients with DS- and DR-TB, respectively. On average, patients incurred costs of US$1573 (95%CI: 1361.8-1785.0) per TB episode, including pre-diagnosis and post-diagnosis expenses. Key cost drivers were post-diagnosis nutritional supplements (US$317.6, 95%CI: 232.7-402.6) followed by medical costs (US$85.5, 95%CI: 54.3-116.5) and costs of travel for clinic visits during treatment (US$79.2, 95%CI: 61.9-96.5). In multivariate analysis, predictors of catastrophic costs included positive HIV status (aOR = 3.0, 95%CI:1.1-8.6) and self-employment (aOR = 2.7, 95%CI:1.1-6.5); high education was a protective factor (aOR = 0.1, 95%CI:0.0-0.9).
Although the services offered to patients with TB are free of charge in the Brazilian public health sector, the availability of free diagnosis and treatment services does not alleviate patients' financial burden related to accessing TB care. The study allowed us to identify the costs incurred by patients and suggest actions to mitigate their suffering. In addition, this study established a baseline for monitoring catastrophic costs and fostering a national policy to reduce the costs to patients for TB care in Brazil.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Brazil - epidemiology</subject><subject>Care and treatment</subject><subject>Cost analysis</subject><subject>Costs</subject><subject>Costs and Cost Analysis</subject><subject>COVID-19</subject><subject>Cross-Sectional Studies</subject><subject>Data collection</subject><subject>Diagnosis</subject><subject>Dietary supplements</subject><subject>Drug resistance</subject><subject>Evaluation</subject><subject>Expenditures</subject><subject>Family income</subject><subject>Financial Stress</subject><subject>GDP</subject><subject>Gross Domestic Product</subject><subject>Handbooks</subject><subject>Health facilities</subject><subject>Health services</subject><subject>Households</subject><subject>Humans</subject><subject>Income</subject><subject>Medical care, Cost of</subject><subject>Multivariate analysis</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Public health</subject><subject>Sample size</subject><subject>Statistical analysis</subject><subject>Surveys</subject><subject>Tuberculosis</subject><subject>Tuberculosis - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Noia Maciel, Ethel Leonor</au><au>Negri, Letícya Dos Santos Almeida</au><au>Guidoni, Leticia Molino</au><au>Fregona, Geisa Carlesso</au><au>Johansen, Fernanda Dockhorn Costa</au><au>Sanchez, Mauro Niskier</au><au>Moreira, Adriana da Silva Rezende</au><au>Diaz-Quijano, Fredi Alexander</au><au>Tonini, Maiko</au><au>Zandonade, Eliana</au><au>Ershova, Julia</au><au>Nguhiu, Peter</au><au>Baena, Inés Garcia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The economic burden of households affected by tuberculosis in Brazil: First national survey results, 2019-2021</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2023-12-13</date><risdate>2023</risdate><volume>18</volume><issue>12</issue><spage>e0287961</spage><epage>e0287961</epage><pages>e0287961-e0287961</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a baseline, the magnitude and main drivers of the costs associated with TB disease for patients and their households and to monitor the proportion of households experiencing catastrophic costs in Brazil.
A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors (<18 years old) were interviewed once about costs, time loss, coping measures, income, household expenses, and asset ownership. Total costs, including indirect costs measured as reported household income change, were expressed as a percentage of annual household income. We used descriptive statistics to analyze the cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs.
We interviewed 603 patients, including 538 (89%) with drug-sensitive (DS) and 65 (11%) with drug-resistant (DR) TB. Of 603 affected households, 48.1% (95%CI: 43-53.2) experienced costs above 20% of their annual household income during their TB episode. The proportion was 44.4% and 78.5% among patients with DS- and DR-TB, respectively. On average, patients incurred costs of US$1573 (95%CI: 1361.8-1785.0) per TB episode, including pre-diagnosis and post-diagnosis expenses. Key cost drivers were post-diagnosis nutritional supplements (US$317.6, 95%CI: 232.7-402.6) followed by medical costs (US$85.5, 95%CI: 54.3-116.5) and costs of travel for clinic visits during treatment (US$79.2, 95%CI: 61.9-96.5). In multivariate analysis, predictors of catastrophic costs included positive HIV status (aOR = 3.0, 95%CI:1.1-8.6) and self-employment (aOR = 2.7, 95%CI:1.1-6.5); high education was a protective factor (aOR = 0.1, 95%CI:0.0-0.9).
Although the services offered to patients with TB are free of charge in the Brazilian public health sector, the availability of free diagnosis and treatment services does not alleviate patients' financial burden related to accessing TB care. The study allowed us to identify the costs incurred by patients and suggest actions to mitigate their suffering. In addition, this study established a baseline for monitoring catastrophic costs and fostering a national policy to reduce the costs to patients for TB care in Brazil.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>38091306</pmid><doi>10.1371/journal.pone.0287961</doi><tpages>e0287961</tpages><orcidid>https://orcid.org/0000-0002-0056-4506</orcidid><orcidid>https://orcid.org/0000-0003-3737-5407</orcidid><orcidid>https://orcid.org/0000-0003-4826-3355</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2023-12, Vol.18 (12), p.e0287961-e0287961 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_3072930234 |
| source | Public Library of Science (PLoS) Journals Open Access; MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adolescent Adult Brazil - epidemiology Care and treatment Cost analysis Costs Costs and Cost Analysis COVID-19 Cross-Sectional Studies Data collection Diagnosis Dietary supplements Drug resistance Evaluation Expenditures Family income Financial Stress GDP Gross Domestic Product Handbooks Health facilities Health services Households Humans Income Medical care, Cost of Multivariate analysis Pandemics Patients Public health Sample size Statistical analysis Surveys Tuberculosis Tuberculosis - epidemiology Tuberculosis, Multidrug-Resistant |
| title | The economic burden of households affected by tuberculosis in Brazil: First national survey results, 2019-2021 |
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