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Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities
Author(s) -
Laokri Samia,
DramaixWilmet Michèle,
Kassa Ferdinand,
Anagonou Séverin,
Dujardin Bruno
Publication year - 2014
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12365
Subject(s) - tuberculosis , catastrophic illness , medicine , environmental health , developing country , development economics , economic growth , economics , pathology , oncology
Objectives To inform policy‐making, we measured the risk, causes and consequences of catastrophic expenditures for tuberculosis and investigated potential inequities. Methods Between August 2008 and February 2009, a cross‐sectional study was conducted among all (245) smear‐positive pulmonary tuberculosis patients of six health districts from southern Benin. A standardised survey questionnaire covered the period of time elapsing from onset of tuberculosis symptoms to completion of treatment. Total direct cost exceeding the conventional 10% threshold of annual income was defined as catastrophic and used as principal outcome in a multivariable logistic regression. A sensitivity analysis was performed while varying the thresholds. Results A pure gradient of direct costs of tuberculosis in relation to income was observed. Incidence (78.1%) and intensity (14.8%) of catastrophic expenditure were high; varying thresholds was insensitive to the intensity. Incurring catastrophic expenditure was independently associated with lower‐ and middle‐income quintiles (adjusted odd ratio ( aOR ) = 36.2, 95% CI [12.3–106.3] and aOR = 6.4 [2.8–14.6]), adverse pre‐diagnosis stage ( aOR = 5.4 [2.2–13.3]) and less education ( aOR = 4.1[1.9–8.7]). Households incurred important days lost due to TB, indebtedness (37.1%), dissaving (51.0%) and other coping strategies (52.7%). Conclusions Catastrophic direct costs and substantial indirect and coping costs may persist under the ‘free’ tuberculosis diagnosis and treatment strategy, as well as inequities in financial hardship.