#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Direct costs of illness of patients with chronic cough in rural Malawi—Experiences from Dowa and Ntchisi districts


Autoři: Junious M. Sichali aff001;  Jahangir A. K. Khan aff002;  Elvis M. Gama aff002;  Hastings T. Banda aff001;  Ireen Namakhoma aff001;  Grace Bongololo aff001;  Rachael Thomson aff002;  Berthe Stenberg aff003;  S. Bertel Squire aff002
Působiště autorů: Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi aff001;  Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, Liverpool, United Kingdom aff002;  LHL’s International Tuberculosis Foundation (LHL International), Oslo, Norway aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0225712

Souhrn

Introduction

Chronic cough is a distressing symptom and a common reason for people to seek health care services. It is a symptom that can indicate underlying tuberculosis (TB) and/or chronic airways diseases (CAD) including asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis. In developing countries including Malawi, provision of diagnostic services and clinical management of CAD is rudimentary, so it is thought that patients make costly and unyielding repeated care-seeking visits. There is, however, a lack of information on cost of illness, both direct and indirect, to patients with chronic cough symptom. Such data are needed to inform policy-makers in making decisions on allocating resources for designing and developing the relevant health care services to address universal coverage programmes for CAD. This paper therefore explores health seeking costs associated with chronic cough and explores information on usage of the coping mechanisms which indicate financial hardship, such as borrowing and selling household assets.

Methods

This economic study was nested within a community-based, population-proportional cross-sectional survey of 15,795 individuals aged 15 years and above, in Dowa and Ntchisi districts. The study sought to identify individuals with symptoms of chronic airways disease whose health records documented at least one of the following diagnoses within the previous year: TB, Asthma, COPD, Bronchitis and Lower Respiratory Tract Infection (LRTI). We interviewed these chronic coughers to collect information on socioeconomic and socio-demographic characteristics, health care utilization, and associated costs of care in 2015. We also collected information on how they funded their health seeking costs.

Results

We identified 608 chronic coughers who reported costs in relation to their latest confirmed diagnosis in their hand-held health record. The mean care-seeking cost per patient was US$ 3.9 (95% CI: 3.00–5.03); 2.3 times the average per capita expenditure on health of US$ 1.69. The largest costs were due to transport (US$ 1.4), followed by drugs (US$ 1.3). The costs of non-medical inputs (US$ 2.09) was considerable (52.3%). Nearly a quarter (24.4%) of all the patients reportedly borrowed or/and sold assets/property to finance their healthcare. CCs with COPD and LRTI had 85.6% and 62.0% lower chance of incurring any costs compared with the TB patients and any patients with comorbidity had 2.9 times higher chance to incur any costs than the patients with single disease. COPD, Bronchitis and LRTI patients had 123.9%, 211.4% and 87.9% lower costs than the patients with TB. The patients with comorbidity incurred 53.9% higher costs than those with single disease.

Conclusions

The costs of healthcare per chronic cougher was mainly influenced by the transport and drugs costs. Types of diseases and comorbidity led to significantly different chances of incurring costs as well as difference in magnitude of costs. The costs appeared to be unaffordable for many patients.

Klíčová slova:

Health economics – Diagnostic medicine – Tuberculosis – Socioeconomic aspects of health – Chronic obstructive pulmonary disease – Coughing – Asthma – Psychological defense mechanisms


Zdroje

1. Aikins AG, Unwin N, Agyemang C, Allotey P, Campbell C, Arhinful D. Tackling Africa’s chronic disease burden: from the local to the global. Glob Health. 2010;6:5.

2. Martins P, Rosado-Pinto J, do Céu Teixeira M, Neuparth N, Silva O, Tavares H, et al. Under-report and under diagnosis of chronic respiratory diseases in an African country. Allergy. 2009;64:1061–7. doi: 10.1111/j.1398-9995.2009.01956.x 19210360

3. World Health Organization: The Global Burden of Disease: 2004 Update. WHO; 2008

4. Stanciole AE, Ortegón M, Chisholm D, Lauer JA. Cost effectiveness of strategies to combat chronic obstructive pulmonary disease and asthma in Sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e608. doi: 10.1136/bmj.e608 (Published 2 March 2012). 22389338

5. Van den Boom M, Seita A, Ottmani S, Migliori GB. Finding the way through the respiratory symptoms jungle: PAL can help. Eur Respir J. 2010;36:979–82. doi: 10.1183/09031936.00116810 21037364

6. WHO. Burden of COPD. http://www.who.int/respiratory/copd/burden/en/ Accessed May 20–21 2013.

7. Mathers CD, Lopez AD, Murray CJL. The burden of disease and mortality by condition: data, methods, and results for 2001. In: Lopez AD, Mathers CD, Ezzati M, et al., editors. Global burden of disease and risk factors. Washington (DC): World Bank; 2006. Chapter 3. http://www.ncbi.nlm.nih.gov/books/nbk11808 (accessed 22 May 2013).

8. Jordan TS, Spencer EM, Davies P. Tuberculosis, bronchiectasis, and chronic airflow obstruction. Respiralogy. 2010;16: 623–628.

9. Shete P.B. Haguma P. Miller C.R. Ochom E. Ayakaka I., Davis, et al, 2015. Pathways and costs of care for patients with tuberculosis symptoms in rural Uganda. The International Journal of Tuberculosis and Lung Disease, 19(8), pp.912–917. doi: 10.5588/ijtld.14.0166 26162356

10. Tanimura T, Jaramillo E, Weil D, Raviglione M, Lonnroth K. Financial burden for tuberculosis patients in low- and middleincome countries: a systematic review. Eur Respir J 2014; 43: 1763–1775 doi: 10.1183/09031936.00193413 24525439

11. Bahadori K., Doyle-Waters M.M., Marra C., Lynd L., Alasaly K., Swiston J. et al 2009. Economic burden of asthma: a systematic review. BMC pulmonary medicine, 9(1), p.1.

12. Madan J., Lönnroth K., Laokri S. and Squire S.B., 2015. What can dissaving tell us about catastrophic costs? Linear and logistic regression analysis of the relationship between patient costs and financial coping strategies adopted by tuberculosis patients in Bangladesh, Tanzania and Bangalore, India. BMC health services research, 15(1), p.1.

13. Blanchette C.M., Roberts M.H., Petersen H., Dalal A.A. and Mapel D.W., 2011. Economic burden of chronic bronchitis in the United States: a retrospective case-control study. Int J Chron Obstruct Pulmon Dis, 6, pp.73–81. doi: 10.2147/COPD.S15882 21311695

14. Accordini S., Corsico A., Cerveri I., Gislason D., Gulsvik A., Janson C., et al 2008. The socio-economic burden of asthma is substantial in Europe. Allergy, 63(1), pp.116–124. doi: 10.1111/j.1398-9995.2007.01523.x 18053021

15. Guarascio A.J., Ray S.M., Finch C.K. and Self T.H., 2013. The clinical and economic burden of chronic obstructive pulmonary disease in the USA.ClinicoEconomics and outcomes research: CEOR, 5, pp.235–245.

16. Menzin J., Boulanger L., Marton J., Guadagno L., Dastani H., Dirani R. et al 2008. The economic burden of chronic obstructive pulmonary disease (COPD) in a US Medicare population. Respiratory medicine, 102(9), pp.1248–1256. doi: 10.1016/j.rmed.2008.04.009 18620852

17. Banda HT, Mortimer K, Bello GA, Mbera GB, Namakhoma I, Thomson R, et al, 2015, Informal Health Provider and Practical Approach to Lung Health interventions to improve the detection of chronic airways disease and tuberculosis at primary care level in Malawi: study protocol for a randomised controlled trial. Trials. 2015 Dec 17; 16:576. http://www.ncbi.nlm.nih.gov/pubmed/26679768

18. Abegunde D.O., Mathers C.D., Adam T., Ortegon M. and Strong K., 2007. The burden and costs of chronic diseases in low-income and middle-income countries. The Lancet, 370(9603), pp.1929–1938.

19. Ramsay A, Al-Agbhari N, Scherchand J, Al-Sonboli N, Almotawa A, Gammo M, et al. Direct patient costs associated with tuberculosis diagnosis in Yemen and Nepal. Int J Tuberc Lung Dis. 2010; 14(2):165–70. 20074407

20. Barter DM, Agboola SO, Murray MB, Barnighausen T. Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa: a systematic review. BMC Public Health 2012; 12: 980 doi: 10.1186/1471-2458-12-980 23150901

21. Ukwaja KN, Modebe O, Igwenyi C, Alobu I. The economic burden of tuberculosis care for patients and households in Africa: a systematic review. Int J Tuberc Lung Dis 2012; 16: 733–739. doi: 10.5588/ijtld.11.0193 22410546

22. Laokri S, Amoussouhui A, Ouendo EM, et al. A care pathway analysis of tuberculosis patients in Benin: highlights on direct costs and critical stages for an evidence-based decision-making. PLOS ONE 2014; 9: e96912. doi: 10.1371/journal.pone.0096912 24810007

23. Laokri S., Dramaix-Wilmet M., Kassa F., Anagonou S. and Dujardin B., 2014. Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities. Tropical Medicine & International Health, 19(10), pp.1249–1258.

24. Sekandi J.N., Dobbin K., Oloya J., Okwera A., Whalen C.C. and Corso P.S., 2015. Cost-effectiveness analysis of community active case finding and household contact investigation for tuberculosis case detection in urban Africa. PloS one, 10(2), p.e0117009. doi: 10.1371/journal.pone.0117009 25658592

25. Lawson L., Al-Sonboli N., Al-Aghbari N., Arbide I., Sherchand J.B., Nnamdi, et al., 2016. Patients direct costs to undergo TB diagnosis. Infectious Diseases of Poverty, 5(1), p.1.

26. STOP TB Partnership, 2008, The tool to estimate patients’ costs, http://www.stoptb.org/wg/dots_expansion/tbandpoverty/assets/documents/Tool%20to%20estimate%20Patients'%20Costs.pdf

27. Okunade AA, Suraratdecha C, Benson DA. Determinants of Thailand household healthcare expenditure: the relevance of permanent resources and other correlates. Health Econ. 2010;19(3):365–376. doi: 10.1002/hec.1471 19405046

28. Jones A. A double-hurdle model of cigarette consumption. J Appl Econom. 1989;4(1):23–39.

29. Khan JAM, Ahmed S, Sultana M, Sarker AR, Chakrovorty S, Rahman MH, et al. 2019. The effect of a Community-Based Health Insurance on the Out-of-pocket Payments for Utilizing Medically Trained Providers in Bangladesh, Int Health [In press]

30. O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation. Washington DC: The World Bank; 2008.

31. Cragg J. Some statistical models for limited dependent variables with application to the demand for durable goods. Econom J Econom Soc. 1971;39(5):829–844. http://www.jstor.org/stable/10.2307/1909582. Accessed January 10, 2014.

32. Malawi National Statistics Office, Integrated Household Survey(HIS) 2010-2011- Household Socio-economic characteristic report, 2012, Zomba, Malawi, http://www.nsomalawi.mw/images/stories/data_on_line/economics/ihs/IHS3/IHS3_Report.pdf

33. United Nations Statistics, Classification of Individual Consumption according to Purpose (COICOP)-Extract http://www.ilo.org/public/english/bureau/stat/download/cpi/coicop.pdf

34. Kruk M.E., Goldmann E. and Galea S., 2009. Borrowing and selling to pay for health care in low-and middle-income countries. Health Affairs, 28(4), pp.1056–1066. doi: 10.1377/hlthaff.28.4.1056 19597204


Článok vyšiel v časopise

PLOS One


2019 Číslo 12
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Kurzy

Zvýšte si kvalifikáciu online z pohodlia domova

Aktuální možnosti diagnostiky a léčby litiáz
nový kurz
Autori: MUDr. Tomáš Ürge, PhD.

Všetky kurzy
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#