Abstract：
Despite national programs covering the cost of treatment for tuberculosis (TB) in many countries, TB patients still face substantial costs. The end TB strategy, set by the World Health Organization (WHO), calls for \"zero\" TB households to be affected by catastrophic payments by 2025. This study aimed to measure the catastrophic healthcare payments among TB patients in Egypt, to determine its cost drivers and determinants and to describe the coping strategies. The study utilized an Arabic-validated version of the TB cost tool developed by the WHO for estimating catastrophic healthcare expenditure using the cluster-based sample survey with stratification in seven administrative regions in Alexandria. TB payments were considered catastrophic if the total cost exceeded 20% of the household\'s annual income. A total of 276 patients were interviewed: 76.4% were males, 50.0% were in the age group 18-35, and 8.3% had multidrug-resistant TB. Using the human capital approach, 17.0% of households encountered catastrophic costs compared to 59.1% when using the output approach. The cost calculation was carried out using the Egyptian pound converted to the United States dollars based on 2021 currency values. Total TB cost was United States dollars (USD) 280.28 ± 29.9 with a total direct cost of USD 103 ± 10.9 and a total indirect cost of USD 194.15 ± 25.5. The direct medical cost was the main cost driver in the pre-diagnosis period (USD 150.23 ± 26.89 pre diagnosis compared to USD 77.25 ± 9.91 post diagnosis, p = 0.013). The indirect costs (costs due to lost productivity) were the main cost driver in the post-diagnosis period (USD 4.68 ± 1.18 pre diagnosis compared to USD 192.84 ± 25.32 post diagnosis, p < 0.001). The households drew on multiple financial strategies to cope with TB costs where 66.7% borrowed and 25.4% sold household property. About two-thirds lost their jobs and another two-thirds lowered their food intake. Being female, delay in diagnosis and being in the intensive phase were significant predictors of catastrophic payment. Catastrophic costs were high among TB households in Alexandria and showed wide variation according to the method used for indirect cost estimation. The main cost driver before diagnosis was the direct medical costs, while it was the indirect costs, post diagnosis.
摘要：
尽管许多国家的国家计划涵盖了结核病（TB）的治疗费用，结核病患者仍然面临巨大的成本。结束结核病战略，由世界卫生组织（WHO）制定，呼吁到2025年“零”结核病家庭受到灾难性支付的影响。这项研究旨在衡量埃及结核病患者的灾难性医疗费用，确定其成本动因和决定因素，并描述应对策略。该研究利用了世卫组织开发的经阿拉伯语验证的结核病成本工具，使用基于集群的抽样调查对亚历山大的七个行政区进行了分层，以估算灾难性的医疗保健支出。如果总费用超过家庭年收入的20%，结核病支付被认为是灾难性的。共采访了276名患者：76.4%为男性，在18-35岁年龄段，50.0%的人患有耐多药结核病，8.3%的人患有耐多药结核病。使用人力资本方法，17.0%的家庭遇到灾难性成本，而使用产出方法时这一比例为59.1%。成本计算是使用根据2021年货币价值换算成美元的埃及镑进行的。总结核病成本为280.28±29.9美元，总直接成本为103±10.9美元，总间接成本为194.15±25.5美元。直接医疗费用是诊断前期间的主要费用驱动因素（诊断前150.23±26.89美元，诊断后77.25±9.91美元，p=0.013)。间接成本（由于生产力损失造成的成本）是诊断后期间的主要成本动因（诊断前4.68±1.18美元，诊断后为192.84±25.32美元，p<0.001)。这些家庭采用了多种财务策略来应对结核病成本，其中66.7％的家庭借贷和25.4％的家庭出售财产。大约三分之二的人失去了工作，另外三分之二的人降低了食物摄入量。作为女性，诊断延迟和处于密集阶段是灾难性支付的重要预测因素。亚历山大结核病家庭的灾难性成本很高，根据用于间接成本估算的方法，差异很大。诊断前的主要成本驱动因素是直接医疗成本，虽然这是间接成本，诊断后。
