New Delhi: A new study has thrown considerable light on the long-term impact of tuberculosis (TB) on patients a year after the end of treatment. The study asserts that India still has a long way to go to reach the goal of zero catastrophic costs for all patient groups, as stated in the END TB Strategy.
The study has been published in the PLOS Global Public Health, in a paper co-authored by Dr Sushmita Chaterjee, Senior Health Economist, The George Institute of Global Health, Palash Das, Research Fellow, the George Institute India, Aaron Shikhule, University of New South Wales Australia, Radha Munje, Indira Gandhi Government Medical College, and Anna Vassal, London School of Hygiene and Tropical Medicine (UK).
The study, conducted between 2019 and 2021, examined the experiences of 829 adult patients who had TB that is responsive to medication (drug-susceptible TB).
“The observations were disturbing, as the total cost of TB treatment from the onset of symptoms to one year post-treatment ranged from Rs 26,500 to Rs 30,500 per patient, despite free diagnosis and treatment provided by the government,” the study indicated.
Further study stated that 32 to 44 per cent of costs were incurred in the pre-treatment phase (i.e., from the initiation of TB symptoms until the initiation of treatment), while six to seven per cent were incurred in the post-treatment phase. The unemployment rate was seen to increase from pre-treatment (before TB) to the intensive phase (i.e., at the beginning of TB treatment), but decrease during the continuation phase (i.e., at the end of TB treatment), although it remained above the baseline even after about one year of treatment completion.
Elaborating on the details of the survey, Dr Chatterjee said, “The collected data covered socio-economic conditions, employment status, patient and household income, out-of-pocket expenses, and time spent on outpatient visits, hospitalisation related to TB, TB drug pick-up, medical follow-ups after initiation of TB treatment, expenses on additional food during TB treatment, and coping strategies such as dissaving, borrowing, and selling assets.”
The scientists have recommended a few strategic solutions to reduce the catastrophic impacts of TB in India. Reducing delays in diagnosis and treatment initiation can reduce the costs associated with TB treatment, its aftermath, and its related economic consequences. In India, on average, patients visit 12 healthcare providers before getting diagnosed with TB.
It also talks about creating awareness about the symptoms of TB in the community and how the availability of free diagnostic and treatment facilities in the government sector is crucial in this regard. Scientists also recommend that policy changes must ensure that the livelihood of TB patients is not disrupted, and hence, the changes should include the provision of job security, additional food support, better management of direct benefit transfers, and improved medical insurance coverage.
“India bears the highest burden of TB in the world, with 26.4 lakh cases reported in 2019 alone. Not only does the disease impact the health of individuals, but it also has significant economic consequences, and we quantified those consequences to take protective action,” Dr Chatterjee added.