Estimating Catastrophic Costs Due to Pulmonary Tuberculosis in Bangladesh

To eliminate TB from the country by the year 2030, the Bangladesh National Tuberculosis (TB) Program is providing free treatment to TB patients since 1993. However, the patients are still to make Out-of-their Pocket (OOP) payment, particularly before their enrollment Directly Observed Treatment Short-course (DOTS). This places a significant economic burden on poor-households. The article, therefore, aimed to estimate the Catastrophic Health Expenditure (CHE) due to TB as well as understand associated difficulties faced by the families when a productive family member age (15–55) suffers from TB. The majority of the OOP expenditures occur before enrolling in.  A cross-sectional study was conducted using multistage sampling in the areas of Bangladesh where Building Resources Across Communities (BRAC) provided TB treatment during June 2016. In total, 900 new TB patients, aged 15–55 years, were randomly selected from a list collected from the BRAC program. CHE was defined as the OOP payments that exceeded 10% of total consumption expenditure of the family and 40% of total non-food expenditure/capacity-to-pay. Regular and Bayesian simulation techniques with 10,000 replications of re-sampling with replacement were used to examine the robustness of the study findings. Linear regression and logit model was used to identify the drivers of OOP payments and CHE, respectively. Multiple regression model showed that the risk of CHE increased among male patients with smear-negative TB and delayed enrolling in the DOTS. Findings suggested that specific groups are more vulnerable to CHE who needs to be brought under innovative safety-net schemes.

Authors: Chowdhury, Anita Sharif; Ahmed, Md Shakil; Ahmed, Sayem; Khanam, Fouzia; Farjana, Fariha; Reza, Saifur; Islam, Shayla; Islam, Akramul; Khan, Jahangir A M; Rahman, Mahfuzar
Type: Journal Article
Year: 2020