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Free Content Free tuberculosis diagnosis and treatment are not enough: patient cost evidence from three continents

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SETTING: The National Tuberculosis Programs of Ghana, Viet Nam and the Dominican Republic.

OBJECTIVE: To assess the direct and indirect costs of tuberculosis (TB) diagnosis and treatment for patients and households.

DESIGN: Each country translated and adapted a structured questionnaire, the Tool to Estimate Patients' Costs. A random sample of new adult patients treated for at least 1 month was interviewed in all three countries.

RESULTS: Across the countries, 27–70% of patients stopped working and experienced reduced income, 5–37% sold property and 17–47% borrowed money due to TB. Hospitalisation costs (US42–118) and additional food items formed the largest part of direct costs during treatment. Average total patient costs (US538–1268) were equivalent to approximately 1 year of individual income.

CONCLUSION: We observed similar patterns and challenges of TB-related costs for patients across the three countries. We advocate for global, united action for TB patients to be included under social protection schemes and for national TB programmes to improve equitable access to care.
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Keywords: Dominican Republic; Ghana; Viet Nam; tuberculosis

Document Type: Research Article

Affiliations: 1: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands; KNCV Tuberculosis Foundation, The Hague, The Netherlands 2: National TB Control Programme, Accra, Ghana 3: Dodowa Health Research Centre Ghana Health, Dodowa, Greater Accra Region, Ghana 4: Management Sciences for Health, Arlington, Virginia, USA 5: Ministry of Public Health, Santo Domingo, Dominican Republic 6: Servicio de Neumologia Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic; ProFamilia, Santo Domingo, Dominican Republic 7: Stop TB Department, World Health Organization, Geneva, Switzerland 8: National Tuberculosis Programme, Hanoi, Viet Nam; National Lung Hospital, Hanoi, Viet Nam 9: National Tuberculosis Programme, Hanoi, Viet Nam; Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France 10: KNCV Tuberculosis Foundation, The Hague, The Netherlands; Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands

Publication date: March 1, 2013

More about this publication?
  • 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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