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Cost of tuberculosis diagnosis and treatment from the patient perspective in Lusaka, Zambia

Authors: Aspler, A.1; Menzies, D.2; Oxlade, O.2; Banda, J.3; Mwenge, L.3; Godfrey-Faussett, P.4; Ayles, H.5

Source: The International Journal of Tuberculosis and Lung Disease, Volume 12, Number 8, August 2008 , pp. 928-935(8)

Publisher: International Union Against Tuberculosis and Lung Disease

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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.

Keywords: Zambia; economics; patient costs; tuberculosis

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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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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