There’s no such thing as a free TB diagnosis: Catastrophic TB costs in Urban Uganda

ABSTRACT

Identifying and reducing TB-related costs is necessary for achieving the End TB Strategy’s goal that no family is burdened with catastrophic costs. This study explores costs during the pre-diagnosis period and assesses the potential for using coping costs as a proxy indicator for catastrophic costs when comprehensive surveys are not feasible. Detailed interviews about TB-related costs and productivity losses were conducted with 196 pulmonary TB patients in Kampala, Uganda. The threshold for catastrophic costs was defined as 20% of household income. Multivariable regression analyses were used to assess the influence of patient characteristics on economic burden, and the positive predictive value (PPV) of coping costs was estimated. Over 40% of patients experienced catastrophic costs, with average (median) pre-diagnosis costs making up 30.6% (14.1%) of household income. Low-income status (AOR = 2.91, 95% CI = 1.29, 6.72), hospitalisation (AOR = 8.66, 95% CI = 2.60; 39.54), and coping costs (AOR = 3.84, 95% CI = 1.81; 8.40) were significantly associated with the experience of catastrophic costs. The PPV of coping costs as an indicator for catastrophic costs was estimated to be 73% (95% CI = 58%, 84%). TB patients endure a substantial economic burden during the pre-diagnosis period, and identifying households that experience coping costs may be a useful proxy measure for identifying catastrophic costs.

KEYWORDS:

• Catastrophic costs
• cost analysis
• dissaving
• tuberculosis (TB)
• Uganda

Acknowledgements

We would like to express our gratitude to the COHSONET research study team, Damalie Nakkonde, Denis Kimbugwe, Jonah Lubega, Nicolas Kawuki, Mustafah Mubiru, and Joan Namatovu, for their valuable role in data collection. We would also like to thank Robert Kakaire and Hannah Southall from the University of Georgia College of Public Health for assisting us with data management.

Disclosure statement

No potential conflict of interest was reported by the author(s).

ORCID

Rebecca L. Walcott http://orcid.org/0000-0002-5841-3022

Additional information

Funding

This work was partly supported by the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health [grant number R01 AI093856].