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Lancet Glob Health. 2017 Nov;5(11):e1123-e1132. doi: 10.1016/S2214-109X(17)30341-8.

Catastrophic costs potentially averted by tuberculosis control in India and South Africa: a modelling study.

Author information

1
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA. Electronic address: verguet@hsph.harvard.edu.
2
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
3
Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
4
TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
5
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
6
Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
7
Public Health Foundation of India, New Delhi, India.
8
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
9
Global TB Programme, WHO, Geneva, Switzerland.
10
Global TB Programme, WHO, Geneva, Switzerland; Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.

Abstract

BACKGROUND:

The economic burden on households affected by tuberculosis through costs to patients can be catastrophic. WHO's End TB Strategy recognises and aims to eliminate these potentially devastating economic effects. We assessed whether aggressive expansion of tuberculosis services might reduce catastrophic costs.

METHODS:

We estimated the reduction in tuberculosis-related catastrophic costs with an aggressive expansion of tuberculosis services in India and South Africa from 2016 to 2035, in line with the End TB Strategy. Using modelled incidence and mortality for tuberculosis and patient-incurred cost estimates, we investigated three intervention scenarios: improved treatment of drug-sensitive tuberculosis; improved treatment of multidrug-resistant tuberculosis; and expansion of access to tuberculosis care through intensified case finding (South Africa only). We defined tuberculosis-related catastrophic costs as the sum of direct medical, direct non-medical, and indirect costs to patients exceeding 20% of total annual household income. Intervention effects were quantified as changes in the number of households incurring catastrophic costs and were assessed by quintiles of household income.

FINDINGS:

In India and South Africa, improvements in treatment for drug-sensitive and multidrug-resistant tuberculosis could reduce the number of households incurring tuberculosis-related catastrophic costs by 6-19%. The benefits would be greatest for the poorest households. In South Africa, expanded access to care could decrease household tuberculosis-related catastrophic costs by 5-20%, but gains would be seen largely after 5-10 years.

INTERPRETATION:

Aggressive expansion of tuberculosis services in India and South Africa could lessen, although not eliminate, the catastrophic financial burden on affected households.

FUNDING:

Bill & Melinda Gates Foundation.

PMID:
29025634
PMCID:
PMC5640802
DOI:
10.1016/S2214-109X(17)30341-8
[Indexed for MEDLINE]
Free PMC Article

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