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. 2023 Aug 23;8(9):423.
doi: 10.3390/tropicalmed8090423.

Comparing Catastrophic Costs: Active vs. Passive Tuberculosis Case Finding in Urban Vietnam

Luong V Dinh  1 , Anja M C Wiemers  2 , Rachel J Forse  2   3 , Yen T H Phan  4 , Andrew J Codlin  2   3 , Kristi Sidney Annerstedt  3 , Thuy T T Dong  2 , Lan Nguyen  5 , Thuong H Pham  6 , Lan H Nguyen  7 , Ha M T Dang  7 , Mac H Tuan  8 , Phuc Thanh Le  9 , Knut Lonnroth  3 , Jacob Creswell  10 , Amera Khan  10 , Beatrice Kirubi  10 , Hoa B Nguyen  1 , Nhung V Nguyen  1 , Luan N Q Vo  2   3
Affiliations

Comparing Catastrophic Costs: Active vs. Passive Tuberculosis Case Finding in Urban Vietnam

Luong V Dinh et al. Trop Med Infect Dis. .

Abstract

Active case finding (ACF) is a strategy that aims to identify people with tuberculosis (TB) earlier in their disease. This outreach approach may lead to a reduction in catastrophic cost incurrence (costs exceeding 20% of annual household income), a main target of WHO's End TB Strategy. Our study assessed the socio-economic impact of ACF by comparing patient costs in actively and passively detected people with TB. Longitudinal patient cost surveys were prospectively fielded for people with drug-sensitive pulmonary TB, with 105 detected through ACF and 107 passively detected. Data were collected in four Vietnamese cities between October 2020 and March 2022. ACF reduced pre-treatment (USD 10 vs. 101, p < 0.001) and treatment costs (USD 888 vs. 1213, p < 0.001) in TB-affected individuals. Furthermore, it reduced the occurrence of job loss (15.2% vs. 35.5%, p = 0.001) and use of coping strategies (28.6% vs. 45.7%, p = 0.004). However, catastrophic cost incurrence was high at 52.8% and did not differ between cohorts. ACF did not significantly decrease indirect costs, the largest contributor to catastrophic costs. ACF reduces costs but cannot sufficiently reduce the risk of catastrophic costs. As income loss is the largest driver of costs during TB treatment, social protection schemes need to be expanded.

Keywords: active case finding; catastrophic cost; out of pocket; social protection; tuberculosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
Comparison of total costs/annual household income ratio frequency in ACF and PCF cohort.
Figure 1
Figure 1
Map of this study’s sampling sites.
Figure 2
Figure 2
Comparison of catastrophic cost incurrence (total costs exceeding 20% of annual household income pre-TB) and socio-economic consequences; poverty line defined as personal income < USD 1.90/day; * chi-square test.
Figure 3
Figure 3
Median monthly household income (USD) over the course of treatment.
See this image and copyright information in PMC

References

    1. Lönnroth K., Jaramillo E., Williams B.G., Dye C., Raviglione M. Drivers of Tuberculosis Epidemics: The Role of Risk Factors and Social Determinants. Soc. Sci. Med. 2009;68:2240–2246. doi: 10.1016/j.socscimed.2009.03.041. - DOI - PubMed
    1. Sachdeva K.S., Kumar N. Closing the Gaps in Tuberculosis Detection—Considerations for Policy Makers. Lancet Glob. Health. 2023;11:e185–e186. doi: 10.1016/S2214-109X(23)00008-6. - DOI - PubMed
    1. Global Tuberculosis Programme . Global Tuberculosis Report 2022. World Health Organization; Geneva, Switzerland: 2022.
    1. Burke R.M., Nliwasa M., Feasey H.R.A., Chaisson L.H., Golub J.E., Naufal F., Shapiro A.E., Ruperez M., Telisinghe L., Ayles H., et al. Community-Based Active Case-Finding Interventions for Tuberculosis: A Systematic Review. Lancet Public Health. 2021;6:e283–e299. doi: 10.1016/S2468-2667(21)00033-5. - DOI - PMC - PubMed
    1. Yuen C.M., Amanullah F., Dharmadhikari A., Nardell E.A., Seddon J.A., Vasilyeva I., Zhao Y., Keshavjee S., Becerra M.C. Turning off the Tap: Stopping Tuberculosis Transmission through Active Case-Finding and Prompt Effective Treatment. Lancet. 2015;386:2334–2343. doi: 10.1016/S0140-6736(15)00322-0. - DOI - PMC - PubMed