Patient medical costs for tuberculosis treatment and impact on adherence in China: a systematic review

BMC Public Health

Research Article

Helen Smith¹  Paul Garner¹  Shenglan Tang²  Qian Long³  Tuohong Zhang⁴ 

[1] Liverpool School of Tropical Medicine, Liverpool, UK;Liverpool School of Tropical Medicine, Liverpool, UK;World Health Organization, Geneva, Switzerland;School of Public Health, Chongqing Medical University, Chongqing, China;Department of Public Health, University of Helsinki, Helsinki, Finland;School of Public Health, Peking University, Beijing, China;

关键词: Annual Household Income;    Village Doctor;    Free Treatment;    Multidrug Resistant Tuberculosis;    Treatment Completion Rate;   

DOI  :  10.1186/1471-2458-11-393

 received in 2010-12-02, accepted in 2011-05-26,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundCharging for tuberculosis (TB) treatment could reduce completion rates, particularly in the poor. We identified and synthesised studies that measure costs of TB treatment, estimates of adherence and the potential impact of charging on treatment completion in China.MethodsInclusion criteria were primary research studies, including surveys and studies using qualitative methods, conducted in mainland China. We searched MEDLINE, PUBMED, EMBASE, Science Direct, HEED, CNKI to June 2010; and web pages of relevant Chinese and international organisations. Cost estimates were extracted, transformed, and expressed in absolute values and as a percentage of household income.ResultsLow income patients, defined at household or district level, pay a total of US$ 149 to 724 (RMB 1241 to 5228) for medical costs for a treatment course; as a percentage of annual household income, estimates range from 42% to 119%. One national survey showed 73% of TB patients at the time of the survey had interrupted or suspended treatment, and estimates from 9 smaller more recent studies showed that the proportion of patients at the time of the survey who had run out of drugs or were not taking them ranged from 3 to 25%. Synthesis of surveys and qualitative research indicate that cost is the most cited reason for default.ConclusionsDespite a policy of free drug treatment for TB in China, health services charge all income groups, and costs are high. Adherence measured in cross sectional surveys is often low, and the cumulative failure to adhere is likely to be much higher. These findings may be relevant to those concerned with the development and spread of multi-drug resistant TB. New strategies need to take this into account and ensure patient adherence.

【 授权许可】

CC BY   
© Long et al; licensee BioMed Central Ltd. 2011