PDF(Pubmed)
Abstract：
BACKGROUND: In Viet Nam, tuberculosis (TB) represents a devastating life-event with an exorbitant price tag, partly due to lost income from daily directly observed therapy in public sector care. Thus, persons with TB may seek care in the private sector for its flexibility, convenience, and privacy. Our study aimed to measure income changes, costs and catastrophic cost incurrence among TB-affected households in the public and private sector.
METHODS: Between October 2020 and March 2022, we conducted 110 longitudinal patient cost interviews, among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program (NTP) in Ha Noi, Hai Phong and Ho Chi Minh City, Viet Nam. Using a local adaptation of the WHO TB patient cost survey tool, participants were interviewed during the intensive phase, continuation phase and post-treatment. We compared income levels, direct and indirect treatment costs, catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate regression.
RESULTS: The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort (USD 868 vs USD 578; P = 0.010). However, private sector treatment was also significantly costlier (USD 2075 vs USD 1313; P = 0.005), driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants (USD 754 vs USD 164; P < 0.001). This resulted in no significant difference in catastrophic costs between the two cohorts (Private: 55% vs NTP: 52%; P = 0.675). Factors associated with catastrophic cost included being a single-person household [adjusted odds ratio (aOR = 13.71; 95% confidence interval (CI): 1.36-138.14; P = 0.026], unemployment during treatment (aOR = 10.86; 95% CI: 2.64-44.60; P < 0.001) and experiencing TB-related stigma (aOR = 37.90; 95% CI: 1.72-831.73; P = 0.021).
CONCLUSIONS: Persons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the public or private sector. Patient costs could be reduced through expanded insurance reimbursement to minimize direct medical costs in the private sector, use of remote monitoring and multi-week/month dosing strategies to avert economic costs in the public sector and greater access to social protection mechanism in general.
METHODS: Between October 2020 and March 2022, we conducted 110 longitudinal patient cost interviews, among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program (NTP) in Ha Noi, Hai Phong and Ho Chi Minh City, Viet Nam. Using a local adaptation of the WHO TB patient cost survey tool, participants were interviewed during the intensive phase, continuation phase and post-treatment. We compared income levels, direct and indirect treatment costs, catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate regression.
RESULTS: The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort (USD 868 vs USD 578; P = 0.010). However, private sector treatment was also significantly costlier (USD 2075 vs USD 1313; P = 0.005), driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants (USD 754 vs USD 164; P < 0.001). This resulted in no significant difference in catastrophic costs between the two cohorts (Private: 55% vs NTP: 52%; P = 0.675). Factors associated with catastrophic cost included being a single-person household [adjusted odds ratio (aOR = 13.71; 95% confidence interval (CI): 1.36-138.14; P = 0.026], unemployment during treatment (aOR = 10.86; 95% CI: 2.64-44.60; P < 0.001) and experiencing TB-related stigma (aOR = 37.90; 95% CI: 1.72-831.73; P = 0.021).
CONCLUSIONS: Persons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the public or private sector. Patient costs could be reduced through expanded insurance reimbursement to minimize direct medical costs in the private sector, use of remote monitoring and multi-week/month dosing strategies to avert economic costs in the public sector and greater access to social protection mechanism in general.
摘要：
背景：在越南，结核病（TB）代表了一个毁灭性的生命事件，价格过高，部分原因是由于公共部门护理中每天直接观察治疗的收入损失。因此，结核病患者可以在私营部门寻求治疗，以提高其灵活性，便利性，和隐私。我们的研究旨在衡量收入变化，公共和私营部门受结核病影响家庭的成本和灾难性成本。
方法：在2020年10月至2022年3月之间，我们进行了110次纵向患者费用访谈，在河内接受结核病私人治疗的50名患者和国家结核病计划（NTP）治疗的60名结核病患者中，海防和胡志明市，越南。使用世卫组织结核病患者费用调查工具的本地调整，参与者在密集阶段接受了采访，延续阶段和治疗后。我们比较了收入水平，直接和间接治疗成本，使用Wilcoxon秩和和卡方检验的灾难性成本以及使用多元回归的两个队列之间的相关危险因素。
结果：与NTP队列相比，私营部门的治疗前家庭收入中位数明显更高（868美元对578美元；P=0.010）。然而,私营部门的治疗费用也明显更高(2075美元对1313美元；P=0.005)，由直接医疗费用驱动，该费用比NTP参与者报告的费用高4.6倍（754美元对164美元；P<0.001）。这导致两个队列之间的灾难性成本没有显着差异（私人：55％vsNTP：52％；P=0.675）。与灾难性成本相关的因素包括单身家庭[调整后的优势比（aOR=13.71；95％置信区间（CI）：1.36-138.14；P=0.026]，治疗期间的失业率(aOR=10.86;95%CI:2.64-44.60;P<0.001)和经历TB相关的病耻感(aOR=37.90;95%CI:1.72-831.73;P=0.021)。
结论：越南的结核病患者无论在公共或私营部门治疗，都面临着同样高的灾难性费用风险。可以通过扩大保险报销来降低患者费用，以最大程度地减少私营部门的直接医疗费用，使用远程监测和多周/月给药策略，以避免公共部门的经济成本和更多地获得一般的社会保护机制。
方法：在2020年10月至2022年3月之间，我们进行了110次纵向患者费用访谈，在河内接受结核病私人治疗的50名患者和国家结核病计划（NTP）治疗的60名结核病患者中，海防和胡志明市，越南。使用世卫组织结核病患者费用调查工具的本地调整，参与者在密集阶段接受了采访，延续阶段和治疗后。我们比较了收入水平，直接和间接治疗成本，使用Wilcoxon秩和和卡方检验的灾难性成本以及使用多元回归的两个队列之间的相关危险因素。
结果：与NTP队列相比，私营部门的治疗前家庭收入中位数明显更高（868美元对578美元；P=0.010）。然而,私营部门的治疗费用也明显更高(2075美元对1313美元；P=0.005)，由直接医疗费用驱动，该费用比NTP参与者报告的费用高4.6倍（754美元对164美元；P<0.001）。这导致两个队列之间的灾难性成本没有显着差异（私人：55％vsNTP：52％；P=0.675）。与灾难性成本相关的因素包括单身家庭[调整后的优势比（aOR=13.71；95％置信区间（CI）：1.36-138.14；P=0.026]，治疗期间的失业率(aOR=10.86;95%CI:2.64-44.60;P<0.001)和经历TB相关的病耻感(aOR=37.90;95%CI:1.72-831.73;P=0.021)。
结论：越南的结核病患者无论在公共或私营部门治疗，都面临着同样高的灾难性费用风险。可以通过扩大保险报销来降低患者费用，以最大程度地减少私营部门的直接医疗费用，使用远程监测和多周/月给药策略，以避免公共部门的经济成本和更多地获得一般的社会保护机制。
