Catastrophic Expenditure of multi-drug resistance tuberculosis on household in Pakistan - A Cross-Sectional Study

Abstract

Background: The Catastrophic Expenditure of Multi-Drug Resistant Tuberculosis on the household in Pakistan. A Cross-sectional study. Patients with MDR-TB incur huge costs associated with the disease while pursuing and receiving health care. Such costs make access and adherence barriers that affect health outcomes and increase the transmission of disease. Objective: The current research ascertained the percentage of Pakistan MDR-TB-affected households experiencing catastrophic expenditures and key cost drivers. Methodology: A cross-sectional survey with retrospective data collection and projections was conducted in 2022. A total of 212 multidrug-resistant (MDR) TB patients were consecutively enrolled 2 weeks into the intensive or continuation phase of treatment. across two districts and three healthcare facilities, all patients were enrolled in these PMDT sites where MDR-TB treatment facilities were in place. Results: Of the 212 respondents, for every single TB episode, patients on average incurred costs of PKR 0.36 million Multidrug-resistant tuberculosis (MDR TB) episodes. Up to 74 % of households borrowed, used savings, or sold assets to defray these costs. More than half (95.28) of TB-affected households experienced TB-related costs above 20% of their annual household expenditure, with the main cost drivers being non-medical expenditures such as travel, nutritional supplements, and food. It was observed that the cost of MDR-TB care is catastrophic for more than  95% (95 by human capital approach and 98% output approach) of the MDR-TB-affected households in Pakistan; our findings support the results from other surveys recently conducted in other countries. Conclusion: Collaborative efforts across health, employment, and social welfare sectors are imperative to minimize household costs due to TB disease and improve access to care, patient adherence, and outcomes.

Key words: Catastrophic costs, Dissaving, Direct medical costs, Direct non-medical costs, Indirect cost