PDF(Pubmed)
Abstract：
To eliminate TB from the country by the year 2030, the Bangladesh National Tuberculosis (TB) Program is providing free treatment to the TB patients since 1993. However, the patients are still to make Out-of-their Pocket (OOP) payment, particularly before their enrollment Directly Observed Treatment Short-course (DOTS). This places a significant economic burden on poor-households. We, therefore, aimed to estimate the Catastrophic Health Expenditure (CHE) due to TB as well as understand associated difficulties faced by the families when a productive family member age (15-55) suffers from TB. The majority of the OOP expenditures occur before enrolling in. We conducted a cross-sectional study using multistage sampling in the areas of Bangladesh where Building Resources Across Communities (BRAC) provided TB treatment during June 2016. In total, 900 new TB patients, aged 15-55 years, were randomly selected from a list collected from BRAC program. CHE was defined as the OOP payments that exceeded 10% of total consumption expenditure of the family and 40% of total non-food expenditure/capacity-to-pay. Regular and Bayesian simulation techniques with 10,000 replications of re-sampling with replacement were used to examine robustness of the study findings. We also used linear regression and logit model to identify the drivers of OOP payments and CHE, respectively. The average total cost-of-illness per patient was 124 US$, of which 68% was indirect cost. The average CHE was 4.3% of the total consumption and 3.1% of non-food expenditure among the surveyed households. The poorest quintile of the households experienced higher CHE than their richest counterpart, 5% vs. 1%. Multiple regression model showed that the risk of CHE increased among male patients with smear-negative TB and delayed enrolling in the DOTS. Findings suggested that specific groups are more vulnerable to CHE who needs to be brought under innovative safety-net schemes.
摘要：
为了在2030年之前从该国消除结核病，孟加拉国国家结核病（TB）计划自1993年以来一直为结核病患者提供免费治疗。然而,患者仍需支付自付(OOP)费用，特别是在他们入学之前直接观察治疗短期疗程(DOTS)。这给贫困家庭带来了巨大的经济负担。我们,因此,旨在估计由于结核病引起的灾难性健康支出（CHE），并了解当生产性家庭成员年龄（15-55岁）患有结核病时家庭面临的相关困难。大部分OOP支出发生在登记之前。我们在孟加拉国2016年6月开展了一项横断面研究，在该地区，跨社区建设资源（BRAC）提供了结核病治疗。总的来说,900例新结核病患者，15-55岁,从BRAC程序收集的列表中随机选择。CHE被定义为OOP支付超过家庭总消费支出的10％和非食品支出/支付能力的40％。使用常规和贝叶斯模拟技术，重复10,000次重新采样并进行替换，以检查研究结果的稳健性。我们还使用线性回归和logit模型来识别OOP支付和CHE的驱动因素，分别。每名病人的平均总费用为124美元，其中68%为间接成本。在接受调查的家庭中，平均CHE占总消费的4.3%和非食品支出的3.1%。最贫穷的五分之一家庭比最富有的家庭经历了更高的CHE，5%vs.1%。多元回归模型显示，涂片阴性TB和DOTS延迟注册的男性患者发生CHE的风险增加。研究结果表明，特定群体更容易受到CHE的影响，需要将其纳入创新的安全网计划。
