Catastrophic costs potentially averted by tuberculosis control in India and South Africa: a modelling study.


Verguet, S; Riumallo-Herl, C; Gomez, GB; Menzies, NA; Houben, RMGJ; Sumner, T; Lalli, M; White, RG; Salomon, JA; Cohen, T; Foster, N; Chatterjee, S; Sweeney, S; Baena, IG; Lönnroth, K; Weil, DE; Vassall, A; (2017) Catastrophic costs potentially averted by tuberculosis control in India and South Africa: a modelling study. The Lancet Global health, 5 (11). e1123-e1132. ISSN 2214-109X DOI: https://doi.org/10.1016/S2214-109X(17)30341-8

[img]
Preview
Text - Published Version
License:

Download (581kB) | Preview

Abstract

The economic burden on households affected by tuberculosis through costs to patients can be catastrophic. WHO's End TB Strategy recognises and aims to eliminate these potentially devastating economic effects. We assessed whether aggressive expansion of tuberculosis services might reduce catastrophic costs. We estimated the reduction in tuberculosis-related catastrophic costs with an aggressive expansion of tuberculosis services in India and South Africa from 2016 to 2035, in line with the End TB Strategy. Using modelled incidence and mortality for tuberculosis and patient-incurred cost estimates, we investigated three intervention scenarios: improved treatment of drug-sensitive tuberculosis; improved treatment of multidrug-resistant tuberculosis; and expansion of access to tuberculosis care through intensified case finding (South Africa only). We defined tuberculosis-related catastrophic costs as the sum of direct medical, direct non-medical, and indirect costs to patients exceeding 20% of total annual household income. Intervention effects were quantified as changes in the number of households incurring catastrophic costs and were assessed by quintiles of household income. In India and South Africa, improvements in treatment for drug-sensitive and multidrug-resistant tuberculosis could reduce the number of households incurring tuberculosis-related catastrophic costs by 6-19%. The benefits would be greatest for the poorest households. In South Africa, expanded access to care could decrease household tuberculosis-related catastrophic costs by 5-20%, but gains would be seen largely after 5-10 years. Aggressive expansion of tuberculosis services in India and South Africa could lessen, although not eliminate, the catastrophic financial burden on affected households. Bill & Melinda Gates Foundation.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre: TB Centre
Related URLs:
PubMed ID: 29025634
Web of Science ID: 412525400025
URI: http://researchonline.lshtm.ac.uk/id/eprint/4563985

Statistics


Download activity - last 12 months
Downloads since deposit
43Downloads
89Hits
Accesses by country - last 12 months
Accesses by referrer - last 12 months
Impact and interest
Additional statistics for this record are available via IRStats2

Actions (login required)

Edit Item Edit Item