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Open Access The household economic burden of drug-susceptible TB diagnosis and treatment in The Gambia

OBJECTIVE: To determine the costs and catastrophic costs incurred by drug-susceptible (DS) pulmonary TB patients in The Gambia.

METHODS: This observational study collected cost and socio-economic data using a micro-costing approach from the household perspective from 244 adult DS-TB patients with pulmonary TB receiving treatment through the national treatment programme in The Gambia. We used data collected between 2017 and 2020 using an adapted version of the WHO generic patient cost survey instrument to estimate costs and the proportion of patients experiencing catastrophic costs (≥20% of household income).

RESULTS: The mean total cost of the TB episode was $104.11 (2018 USD). Direct costs were highest before treatment ($22.93). Indirect costs accounted for over 50% of the entire episode costs. Using different income estimation approaches and catastrophic cost thresholds, 0.4–75% of participants encountered catastrophic costs, showing the variability of results given the different assumptions we utilised.

CONCLUSIONS: We show that despite the benefits of free TB care and treatment, DS-TB patients still incur substantial direct and indirect costs, and cases of impoverishing expenditure varied vastly depending on the income estimation approaches used.

Keywords: The Gambia; catastrophic costs; patient costs; tuberculosis

Document Type: Research Article

Affiliations: 1: Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK 2: Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia, Center for International Health, Ludwig-Maximilians-University (LMU) Munich University Hospital, Munich, Germany 3: Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia 4: Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany, German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany 5: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa 6: Department of Public Health Sciences, Karolinska Institute, Sweden 7: Aurum Institute, Johannesburg, South Africa

Publication date: December 1, 2022

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