PURPOSE: To determine the extent of unaccounted expenses of antituberculosis treatment.
METHODS: One year (2007) cross-sectional study to 1. Assess the expenditure involved in tuberculosis diagnosis and treatment 2. Estimate the loss of working days and the consequential loss of income.
RESULTS: Eighty consecutive patients were interviewed; median age:35 years. They had been treated for a median of 4 months. Fifty (64%) were under directly observed therapy (DOT), 20 (26%)under self-administered treatment (SAT), and 8 (10%) initially under DOT and later under SAT. DOT was administered at the health center in 58% of the cases and at home in 42%. It was supervised by health personnel in 87.5% of the cases. Median time to get to the health center was 60 minutes. Forty-eight traveled by bus (65.7%) and 20 (25%) walked to the health center. Patients required 2.4±1.3 bus trips with a median cost of 18 pesos (exchange rate:1 US=11 pesos). For patients under DOT at the health center this would amount up to $360 pesos each month (approximately 10% of their income). Twenty-nine (36.3%) had to buy some medication during treatment, most commonly antituberculosis drugs(48.2%)and 57 (71.2%) had to pay for some of their diagnostic studies (median $500 pesos). Of those that had personal earnings, 33 (56%) earned 1,000 pesos or less per week and 20 (34%) earned $1,000–2,000 pesos per week. Fifty of them (85%) were unable to work due to illness, 90% of them for at least one month (three or more months in 54% of the cases). Patients under health center DOT had to miss or arrive late at work on a daily basis. Fifty-six patients (70%) had no medical insurance or medical coverage.
CONCLUSION: Important unaccounted costs include transportation expenditures, cost of diagnostic studies, complementary medications and lost income.
CLINICAL IMPLICATIONS: Unaccounted costs may constitue a barrier for treatment success. Interventions that reduce the number of health encounters and travel distances are needed.
DISCLOSURE: Rafael Laniado-Laborin, No Financial Disclosure Information; No Product/Research Disclosure Information