Cost of tuberculosis diagnosis and treatment from the patient perspective in Lusaka, Zambia
Abstract:SETTING: Urban primary health centres in Lusaka, Zambia.
OBJECTIVES: 1) To estimate patient costs for tuberculosis (TB) diagnosis and treatment and 2) to identify determinants of patient costs.
METHODS: A cross-sectional survey of 103 adult TB patients who had been on treatment for 1–3 months was conducted using a standardised questionnaire. Direct and indirect costs were estimated, converted into US$ and categorised into two time periods: ‘pre-diagnosis/care-seeking’ and ‘post-diagnosis/treatment’. Determinants of patient costs were analysed using multiple linear regression.
RESULTS: The median total patient costs for diagnosis and 2 months of treatment was $24.78 (interquartile range 13.56–40.30) per patient—equivalent to 47.8% of patients' median monthly income. Sex, patient delays in seeking care and method of treatment supervision were significant predictors of total patient costs. The total direct costs as a proportion of income were higher for women than men (P < 0.001). Treatment costs incurred by patients on the clinic-based directly observed treatment strategy were more than three times greater than those incurred by patients on the self-administered treatment strategy (P < 0.001).
CONCLUSION: Clinic-based treatment supervision posed a significant economic burden on patients. The creation or strengthening of community-based treatment supervision programmes would have the greatest potential impact on reducing patients' TB-related costs.
Document Type: Regular Paper
Affiliations: 1: Respiratory Epidemiology Unit, Montreal Chest Institute, Montreal, Quebec, Canada; and London School of Hygiene & Tropical Medicine, London, UK 2: Respiratory Epidemiology Unit, Montreal Chest Institute, Montreal, Quebec, Canada 3: Zambia AIDS-Related Tuberculosis (ZAMBART) Project, School of Medicine, University of Zambia, Lusaka, Zambia 4: London School of Hygiene & Tropical Medicine, London, UK 5: London School of Hygiene & Tropical Medicine, London, UK; and Zambia AIDS-Related Tuberculosis (ZAMBART) Project, School of Medicine, University of Zambia, Lusaka, Zambia
Publication date: August 1, 2008
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