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. 2015 Dec;19(12):1513-9.
doi: 10.5588/ijtld.15.0341.

Patients' costs associated with seeking and accessing treatment for drug-resistant tuberculosis in South Africa

L Ramma  1 , H Cox  2 , L Wilkinson  3 , N Foster  1 , L Cunnama  1 , A Vassall  4 , E Sinanovic  1
Affiliations

Patients' costs associated with seeking and accessing treatment for drug-resistant tuberculosis in South Africa

L Ramma et al. Int J Tuberc Lung Dis. 2015 Dec.

Abstract

Setting: South Africa is one of the world's 22 high tuberculosis (TB) burden countries, with the second highest number of notified rifampicin-resistant TB (R(R)-TB) and multidrug-resistant TB (MDR-TB) cases.

Objective: To estimate patient costs associated with the diagnosis and treatment of R(R)-TB/MDR-TB in South Africa.

Design: Patients diagnosed with R(R)-TB/MDR-TB and accessing care at government health care facilities were surveyed using a structured questionnaire. Direct and indirect costs associated with accessing R(R)-TB/MDR-TB care were estimated at different treatment durations for each patient.

Results: A total of 134 patients were surveyed: 84 in the intensive phase and 50 in the continuation phase of treatment, 82 in-patients and 52 out-patients. The mean monthly patient costs associated with the diagnosis and treatment of R(R)-TB/MDR-TB were higher during the intensive phase than the continuation phase (US$235 vs. US$188) and among in-patients than among out-patients (US$269 vs. US$122). Patients in the continuation phase and those accessing care as out-patients reported higher out-of-pocket costs than other patients. Most patients did not access social protection for costs associated with R(R)-TB/MDR-TB illness.

Conclusion: Despite free health care, patients bear high costs when accessing diagnosis and treatment services for R(R)-TB/MDR-TB; appropriate social protection mechanisms should be provided to assist them in coping with these costs.

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Conflict of interest statement

Conflicts of interest: no other conflicts declared.

Figures

Figure 1
Figure 1. Distribution of participants according to duration of treatment.
Figure 2
Figure 2. Source of income before initiation of treatment and during treatment.
See this image and copyright information in PMC

Comment in

  • The cost of 'free' tuberculosis care.
    Stout JE. Stout JE. Int J Tuberc Lung Dis. 2015 Dec;19(12):1413. doi: 10.5588/ijtld.15.0818. Int J Tuberc Lung Dis. 2015. PMID: 26614179 No abstract available.

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