Background
Methods
Data sources and search strategies
Data extraction and analysis
Results
Author (Year) | Country | Type of study | Population under study | Primary objectives | Types of costs reported | Time period of costs (Pre vs. post diagnosis) |
---|---|---|---|---|---|---|
Aspler, et al. (1998) [41] | Zambia | Cross-sectional | 103 patients aged ⩾18 years with active or extra-pulmonary TB who had been on treatment for 6-10 weeks | To estimate TB patient costs for treatment and diagnosis and cost determinants | Pre-diagnosis, treatment, time, travel, medication, consultation, hospitalization, food, health insurance, and diagnostic test costs | Both |
Awofeso, N. (1998) [42] | Nigeria | Prospective cohort | 2144 symptomatic smear-positive patients in two study periods | To discuss the implications of pre-payment versus free medication therapy on treatment and case-finding of TB patients | Medication costs | Post-diagnosis |
Bevan, E. (1997) [43] | Kenya | Unknown | Unknown | Letter to describe other costs associated with DOTS | Daily inpatient care, travel, and other medical expenses | Post-diagnosis |
Brouwer, et al. (1998) [44] | Malawi | Cross-sectional | 89 smear-positive pulmonary TB patients admitted to Queen Elizabeth Central Hospital | To investigate how TB patients utilize traditional healers and traditional medicine in their care-seeking behaviors | Total fixed and variable costs, time, and traditional healer costs | Pre-diagnosis |
Cambanis, et al. (2005) [45] | Ethiopia | Cross-sectional | 243 patients undergoing sputum examination for TB diagnosis | To assess factors related to patient delay in presenting to health services for the diagnosis of TB | Time and travel costs | Pre-diagnosis |
Chard, S. (2001) [46] | Uganda | Cross-sectional | 89 female patients aged ⩾18 years identified from a TB clinic | To examine treatment seeking, health beliefs, and social networks of female Ugandan TB patients | Time, travel, medication, traditional healers, and costs for “tipping” healthcare providers | Both |
Chard, S. (2009) [47] | Uganda | Cross-sectional | 65 women aged ⩾18 years with a diagnosis of pulmonary TB, and receiving outpatient TB treatment from one of three TB clinics | To explore the TB treatment-seeking process of Ugandan women in order to determine the routes to effective government TB treatment | Private providers and traditional healer costs | Both |
Datiko and Lindtjørn (2010) [48] | Ethiopia | Cost-effectiveness analysis | 229 smear-positive patients | To determine the cost and cost-effectiveness of involving health extension workers in TB treatment under a community-based model | Time, caregiver, food, direct, and total costs | Post-diagnosis |
Edginton, et al. (2002) [49] | South Africa | Qualitative | 114 hospital TB patients and 75 clinic TB patients and community members were interviewed | To assess the beliefs and experiences about TB from the perspective of patients and community members in order to assess the impact of presentation to health services and treatment adherence | Time and travel costs | Post-diagnosis |
Floyd, et al. (2003) [50] | Malawi | Cost-effectiveness analysis | 2,174 new smear-positive and -negative patients registered for treatment in 1997; 2,821 new smear-positive and -negative patients registered for treatment in 1998 | To assess the cost and cost-effectiveness of new treatment strategies for new pulmonary TB patients introduced in Malawi in 1997 | Time, travel, hospitalization, caregiver, and DOTS costs | Post-diagnosis |
Floyd, et al. (1997) [51] | South Africa | Cost-effectiveness analysis | New smear-positive adult patients | To conduct an economic evaluation of directly observed treatment and conventionally delivered treatment for the management of new adult TB cases | Time, travel, hospitalization, total, and DOTS costs | Post-diagnosis |
Gibson, et al. (1998) [52] | Sierra Leone | Cross-sectional | 54 inpatients, 18 outpatients, and 17 staff members in 6 TB Centers | To evaluate the impact of patient poverty and staff salaries on patient costs for TB treatment within a sub-national TB program | Pre-program, program time, and total costs | Both |
Harper, et al. (2003) [53] | The Gambia | Qualitative | 443 patients and clinic staff participated in focus groups, in-depth interviews, and semi-structured interviews | To evaluate the factors related to shortages of case tracing and adherence to treatment using qualitative methods with a cohort of TB patients | Travel and private treatment costs | Both |
Kemp, et al. (2007) [54] | Malawi | Cross-sectional | 179 smear-positive and -negative TB patients who were in the intensive phase of treatment | To assess the relative costs of accessing a TB diagnosis for the poor and for women in urban Lilongwe, Malawi, where public health services are accessible within 6km and are provided free of charge | Time, travel, medication, and food costs | Both |
Mesfin, et al. (2010) [55] | Ethiopia | Prospective cohort | 537 newly diagnosed smear-positive pulmonary TB patients and 387 newly diagnosed smear-negative pulmonary TB patients ≥15 | To investigate costs of TB diagnosis incurred by patients, their escorts, and the public health system in 10 districts in Ethiopia | Caregiver, time, travel, medication, consultation, hospital admission, and lodging costs | Both |
Moalosi, et al. (2003) [56] | Botswana | Cost-effectiveness analysis | 50 caregivers of TB patients on home-based care | To determine the affordability and cost-effectiveness of home-based DOTS vs. hospital-based DOTS for TB patients and to describe the characteristics of patients and their caregivers | Total, time, travel, medication and hospitalization costs for caregivers | Both |
Needham, et al. (1996) [57] | Zambia | Cross-sectional | 23 adult inpatients and outpatients with a diagnosis of pulmonary TB | Letter in response to Pocock et al. 1996 to assess patient-related economic barriers to TB diagnosis in Lusaka, Zambia | Medical, non-medical, time, and caregiver costs | Both |
Needham, et al. (1998) [58] | Zambia | Cross-sectional | 202 adult inpatients and outpatients registering with new pulmonary TB at the Chest Clinic | To study the pre-diagnosis economic impact burden and barrers to care seeking for TB patients in urban Zambia | Time, travel, consultation, caregiver, private provider, traditional healer, insurance, diagnostic, treatment, and food costs | Both |
Needham, et al. (2004) [59] | Zambia | Qualitative | 202 adult patients with pulmonary tuberculosis | To assess the barriers to successful care seeking faced by TB patients in urban Zambia | Time, travel, caregiver, and government health insurance costs | Pre-diagnosis |
Nganda, et al. (2003) [60] | Kenya | Cost-effectiveness analysis | New smear-positive, new smear-negative and extra-pulmonary adult patients; for each type of patient, two alternative approaches to treatment were evaluated: the conventional approach used until September 1997 and the new approach introduced in October 1997 | To assess the cost and cost-effectiveness of new treatment strategies, involving decentralization of care from hospitals to peripheral health facilities and the community, compared to the conventional approaches used until October 1997 | Total, travel, hospitalization, TB clinic, and DOTS costs | Post-diagnosis |
Okello, et al. (2003) [61] | Uganda | Cost-effectiveness analysis | New smear-positive pulmonary patients under two strategies: the conventional hospital-based approach used from 1995 thorough 1997, and the new community-based approach introduced in 1998 | To assess the cost and cost-effectiveness of conventional hospital-based care with the new community-based care for new smear-positive pulmonary TB patients | Time, travel, hospitalization, and total DOTS costs | Post-diagnosis |
Pocock, et al. (1996) [62] | Malawi | Cross-sectional | 100 adult patients with smear-positive and extrapulmonary TB admitted to the TB ward, Queen Elizabeth Central Hospital, for 2 months of treatment | Letter investigating impacts of long hospitalization from the patients’ perspective | Time costs | Post-diagnosis |
Saunderson, P.R. (1995) [31] | Uganda | Cost-effectiveness analysis | 34 patients attending a hospital run by a non-governmental organization | To analyze the costs and cost-effectiveness of the current TB control strategy and an alternative ambulatory treatment strategy | Total, time, hospitalization, and pre-diagnosis costs | Both |
Sinanovic, et al. (2003) [63] | South Africa | Cost-effectiveness analysis | New smear-positive and retreatment pulmonary TB patients started on treatment in two townships of Metropolitan Cape Town (Guguletu, where both clinic and community care were provided, and Nyanga, whereonly clinic-based care was provided) | To evaluate the affordability and cost-effectiveness of community involvement in TB care | Total, time, and travel costs | Post-diagnosis |
Sinanovic and Kumaranay-ake (2006) [64] | South Africa | Cost-effectiveness analysis | 1,182 new sputum positive patients at 2 public-private workplace sites (PWP), 2 public-non-governmental organization partnership sites (PNP) and 2 purely public sites | To estimate the cost and cost-effectiveness of different types of public-private-partnerships in TB treatment and the financing required for the different models from the provincial TB program from the patient and provider perspective | Total, time, and travel costs | Post-diagnosis |
Steen and Mazonde (1999) [30] | Botswana | Cross-sectional | 212 New and retreated patients with smear-positive pulmonary TB | To estimate the health-seeking behaviors of TB patients and their beliefs and attitudes of the disease | Outpatient fees | Post-diagnosis |
Vassall, et al. (2010) [65] | Ethiopia | Cross-sectional | 250 patients ⩾ 15 years using TB-HIV pilot services and diagnosed with and being treated for TB, HIV, or both | To measure patients costs of TB-HIV services from hospital-based pilot sites for collaborative TB-HIV interventions | Direct, indirect, transport, total | Both |
Wandwalo, et al. (2005) [66] | Tanzania | Cost-effectiveness analysis | 42 treatment supervisors and 103 new smear-positive, smear-negative, and extrapulmonary TB patients 5 years | To determine the cost and cost-effectiveness of community-based DOTS versus health facility treatment of TB in urban Tanzania | Direct, indirect, time, and total costs | Post-diagnosis |
Wilkinson, et al. (1997) [67] | South Africa | Cost-effectiveness analysis | TB patients under the Hlabisa strategy (1991-preent), the former Hlabisa strategy (until 1991), the Department of Health strategy, and the SANTA strategy based on sanatorium care | To conduct an economic analysis of the Hlabisa community-based DOTS management compared to three alternative strategies | Total, hospitalization, and travel costs | Post-diagnosis |
Wyss, et al. (2001) [68] | Tanzania | Cross-sectional | 191 TB cases in 3 surveillance areas who had smear-positive, extrapulmonary, or relapse TB | To assess household level costs of TB and to compare them with provider costs of the National TB Control Program | Diagnostic test, time, traditional healer, private provider, hospitalization, caregiver, and travel costs | Both |
Cost categories | Definition | Direct or indirect | Pre- or post-diagnosis | Number of studies reporting cost category | Range (median) of costs |
---|---|---|---|---|---|
Health insurance | Costs required for national health insurance schemes to finance TB care | Direct | Pre-diagnosis | 2 | I$2- I$3 (I$2) |
Consultation or prepayment fees | Costs charged by providers before diagnosis or treatment | Direct | Pre-diagnosis | 4 | I$2- I$7 (I$3) |
Private provider fees | Costs charged in the private sector rather than the public sector | Direct | Both | 4 | I$24- I$141 (I$41) |
Hospitalization | Costs associated with hospitalization due to TB | Direct | Post-diagnosis | 10 | I$1- I$530 (I$80) |
Medication | Costs of medications including standard TB treatment under non-DOTS systems and other drugs | Direct | Post-diagnosis | 5 | I$15- I$548 (I$21)a
|
Diagnostic tests | Costs for tests other than sputum microscopy such as x-rays, chest radiographs, or other laboratory tests | Direct | Pre-diagnosis | 3 | I$7- I$10 (I$9) |
Traditional healer | Costs associated with seeking traditional healers before Western medical care | Direct | Pre-diagnosis | 5 | I$4- I$563 (I$15) |
Food | Costs for regular food and food separate from normal diets such as potatoes, eggs, meat, fruit, and soft drinks [58] | Direct | Post-diagnosis | 4 | I$4- I$36 (I$10) |
Travel | Costs for travel association with pre-diagnosis, consultation, diagnosis, treatment, pill collection, DOTS and follow-up treatment visits. | Direct | Both | 18 | I$0.17- I$70 (I$5) |
Time | Time and indirect costs associated with time spent seeking/receiving care and lost work time | Indirect | Both | 21 | I$0.23- I$412 (I$16)b
|
Caregiver | Costs to those accompanying patients to TB care visits, retrieving medications on their behalf, or cost of care-giving activities. Direct costs encompass travel expenses, food, or other costs such as paying for an overnight stay when making a long journey. Indirect costs include loss of income and time spent accompanying patients or providing care-giving activities. | Both | Both | 8 | I$0.41- I$1,510 (I$11)c
|
Health insurance, prepayment fees, consultation and private provider fees
Author(s) (year) | Country | Cost estimate (I$) | % Annual per-capita income (entire population) | % Annual per-capita income (income-poorest 20% of the population) | Notes |
---|---|---|---|---|---|
Health insurance costs
| |||||
Aspler, et al. [41] | Zambia | 2 | 0.43 | 2 | 67% of patients reported paying median health insurance user fees (IQR I$1.79- I$1.97) |
Needham, et al. [59] | Zambia | 3 | 0.69 | 3a
| Mean monthly fees for government-sponsored health insurance (range I$2-I$3) |
Consultation/prepayment fees
| |||||
Aspler, et al. [41] | Zambia | 4 | 0.78 | 4 | Median one time consultation fee (IQR I$4- I$7) |
Mesfin, et al. [55] | Ethiopia | 2 | 0.93 | 2 | Mean consultation fees per visit (median I$0) |
Needham, et al. [58] | Zambia | 7 | 2 | 10 | Mean one-time consultation fees (median I$8) |
Steen and Masonde [30] | Botswana | 2 | 0.06 | 0.43b
| One-time prepayment outpatient fee |
Private provider fees
| |||||
Chard, S. [47] | Uganda | 141 | 47 | 154c
| Private clinic treatment costs |
Harper, et al. [53] | The Gambia | 44 | 11 | 54d
| Costs spent on private treatment |
Needham, et al. [58] | Zambia | 24 | 6 | 35 | Mean costs to see a private physician (median I$15) |
Wyss, et al. [68] | Tanzania | 38 | 12 | 29e
| Unit cost for private services |
Hospitalization, medication, and diagnostic tests costs
Author(s) (year) | Country | Cost estimate (I$) | % Annual per-capita income (entire population) | % Annual per-capita income (income-poorest 20% of the population) | Notes |
---|---|---|---|---|---|
Hospitalization costs
| |||||
Aspler, et al. [41] | Zambia | 14 | 3 | 16 | Median costs (IQR I$4- I$19) |
Floyd, et al. [51] | South Africa | 119 | 3 | 17a
| Mean cost of 18-day hospital stay under DOTS (I$7 per day) |
Floyd, et al. [51] | South Africa | 407 | 11 | 59a
| Mean cost of 60-day hospital stay under conventional system (I$7/day) |
Floyd, et al. [50] | Malawi | 498 | 262 | 1048 | Mean cost of 58-day hospital stay under hospital-based strategy for smear-positive patients (I$9/day) |
Floyd, et al. [50] | Malawi | 138 | 73 | 289 | Mean cost of 16-day hospital stay under community-based DOTS strategy for smear-positive patients (I$9/day) |
Floyd, et al. [50] | Malawi | 32 | 17 | 66 | Mean cost of 8-day hospital stay under hospital-based and community-based DOTS strategies for smear-negative patients (I$9/day) |
Gibson and Boillot [52] | Sierra Leone | 1 | 0.53 | 2b
| Mean hospital admission fees at a missionary hospital |
Gibson and Boillot [52] | Sierra Leone | 47 | 18 | 58b
| Mean hospital admission fees at a government hospital |
Mesfin, et al. [55] | Ethiopia | 4 | 2 | 5 | Mean cost of hospital admissions (median I$0) |
Nganda, et al. [60] | Kenya | 530 | 101 | 336c
| Mean cost of 60-day hospital stay under hospital-based system for smear-positive patients (I$9/ day) (96% CI I$5- I$13) |
Nganda, et al. [60] | Kenya | 34 | 7 | 22c
| Mean cost of 4-day hospital stay under community-based DOTS for smear-positive patients (I$9/ day) (96% CI I$5- I$13) |
Okello, et al. [61] | Uganda | 219 | 73 | 240d
| Mean cost of 60-day hospital stay under conventional hospital-based care strategy for smear-positive patients (I$4/ day) |
Okello, et al. [61] | Uganda | 70 | 24 | 77d
| Mean cost of 19-day hospital stay under community-based care strategy for smear-positive patients (I$4/ day) |
Saunderson, P. [31] | Uganda | 91 | 39 | 126 | Mean cost for a 2-month hospital stay |
Wilkinson, et al. [67] | South Africa | 139 | 3.62 | 20e
| Mean cost of 17.5-day hospital stay under community-based DOTS strategy (I$8/ day) |
Wyss et al. [68] | Tanzania | 15 | 5 | 12f
| Hospitalization costs reported for one month |
Medication costs
| |||||
Aspler, et al. [41] | Zambia | 15 | 3 | 18 | Median costs for additional medications (IQR I$9- I$21) |
Awofeso, N. [42] | Nigeria | 548g
| 121 | 589h
| Mid-range, one-time medication costs (range I$199- I$897)g
|
Chard, S. [46] | Uganda | 20 | 7 | 22i
| Mean costs for medications (range I$4- I$37) |
Kemp, et al. [54] | Malawi | 50 | 27 | 106j
| Mean costs for smear-negative patients for user fees and drug costs outside of government health facilities (median I$19) |
Kemp, et al. [54] | Malawi | 18 | 9 | 37j
| Mean costs for smear-positive patients for user fees and drug costs outside of government health facilities (median I$6) |
Mesfin, et al. [55] | Ethiopia | 22 | 12 | 25 | Mean costs for additional medications (median I$7) |
Diagnostic test costs
| |||||
Aspler, et al. [41] | Zambia | 7 | 2 | 8 | Median cost for chest radiographic (IQR I$4-I$7) |
Needham, et al. [58] | Zambia | 9 | 2 | 13 | Mean cost for diagnostic tests (unspecified) (median I$13) |
Wyss, et al. [68] | Tanzania | 10 | 3 | 7f
| Unit cost for examination, laboratory, and X-rays |
Traditional healer and food costs
Author(s) (year) | Country | Cost estimate (I$) | % Annual per-capita income (entire population) | % Annual per-capita income (income-poorest 20% of the population) | Notes |
---|---|---|---|---|---|
Traditional healer costs
| |||||
Brouwer, et al. [44] | Malawi | 4 | 2 | 9a
| Weighted mean of traditional healer costs (range I$0- I$28)b
|
Chard, S. [47] | Uganda | 563 | 188 | 618c
| One study participant reported this cost for a traditional healer |
Chard, S. [46] | Uganda | 15 | 5 | 16c
| Mid-point estimate (range I$2-I$10). A few patients in the sample reported to pay roughly I$495 |
Needham, et al. [58] | Zambia | 17 | 4 | 25 | Average cost to see a traditional healer (median I$7) |
Wyss, et al. [68] | Tanzania | 13 | 4 | 10d
| Unit cost to see a traditional healer |
Food costs
| |||||
Aspler, et al. [[41] | Zambia | 4 | 0.78 | 4 | Median food costs (IQR I$1- I$7) |
Datiko and Lindtjørn [48] | Ethiopia | 14 | 7 | 15e
| Mean food costs for a community-based DOTS treatment program (sd I$12) |
Datiko and Lindtjørn [48] | Ethiopia | 36 | 17 | 37e
| Mean food costs for a health-facility-based DOTS treatment program (sd I$21) |
Kemp, et al. [54] | Malawi | 7 | 4 | 15f
| Mean food costs for smear-negative patients (median I$2) |
Kemp, et al. [54] | Malawi | 10 | 5 | 21f
| Mean food costs for smear-positive patients (median I$0) |
Needham, et al. [58] | Zambia | 3 | 1 | 5 | Mean food cost (median I$2) |
Needham, et al. [58] | Zambia | 36 | 9 | 53 | Mean cost for “special” foodsg (median I$19) |
Travel costs
Author(s) year | Country | Cost estimate (I$) | % monthly per-capita income (entire population) | % monthly per-capital income (income-poorest 20% of the population) | Notes |
---|---|---|---|---|---|
Aspler, et al. [41] | Zambia | 3 | 8 | 43 | Median costs for pre-diagnosis (IQR I$1- I$7) |
Aspler, et al. [41] | Zambia | 12 | 31 | 171 | Median costs for pill collection visits (IQR I$4- I$29) |
Aspler, et al. [41] | Zambia | 4 | 10 | 57 | Median costs for follow-up visits (IQR I$2- I$4) |
Bevan, E. [43] | Kenya | 5 | 11 | 35 | Daily cost to travel to a designated DOTS center |
Cambanis, et al. [45] | Ethiopia | 7 | 47 | 100a
| Mean costs for transport to a health facility |
Chard, S. [46] | Uganda | 3 | 14 | 45b
| Mean transportation costs to a health facility in Kampala |
Chard, S. [46] | Uganda | 5 | 21 | 67b
| Mean transportation costs to a health facility in Mukono |
Datiko and Lindtjorn [48] | Ethiopia | 2 | 14 | 31c
| Mean transport costs for a community-based DOTS treatment program (sd I$5) |
Datiko and Lindtjorn [48] | Ethiopia | 15 | 88 | 188c
| Mean transport costs for a health facility-based DOTS treatment program (sd I$43) |
Edginton, et al. [49] | South Africa | 3 | 0.96 | 7d
| Mid-point costs for 69% of hospital attendees and 48% of clinic attendees (range I$0.52-I$5)e
|
Floyd, et al. [51] | South Africa | 12 | 4 | 20f
| Mean travel cost for a hospital visit |
Floyd, et al. [51] | South Africa | 2 | 0.74 | 4f
| Mean travel cost for a health clinic visit |
Floyd, et al. [51] | South Africa | 0.17 | 0.05 | 0.30f
| Mean travel cost for a health clinic DOTS visit |
Floyd, et al. [51] | South Africa | 0.85 | 0.27 | 1f
| Mean travel cost for a TB ward DOTS visit |
Floyd, et al. [50] | Malawi | 4 | 26 | 102 | Mean costs for visit to a health center to collect drugs for smear-positive and -negative patients under hospital and community-based strategies (I$18 for average 5 visits) |
Harper, et al. [53] | The Gambia | 0.55 | 2 | 8g
| Mean daily fare to attend a TB clinic (range I$0.44-I$0.66) |
Kemp, et al. [54] | Malawi | 18 | 116 | 456h
| Mean transport costs for smear-positive patients (median I$11) |
Kemp, et al. [54] | Malawi | 13 | 81 | 319h
| Mean transport costs for smear-negative patients (median I$5) |
Mesfin, et al. [55] | Ethiopia | 11 | 72 | 155 | Mean transport costs for visiting a public health facility pre-diagnosis |
Needham, et al. [58] | Zambia | 9 | 26 | 150 | Mean transportation cost during treatment (median I$3) |
Nganda, et al. [60] | Kenya | 9 | 20 | 67i
| Mean cost for a visit to collect drugs from a health facility for smear-positive patients under conventional and community-based strategies for smear-positive patients (I$44 for average 5 visits)j
|
Okello, et al. [61] | Uganda | 6 | 24 | 78k
| Mean costs to the nearest health facility in an outpatient system and costs to collect drugs under the conventional hospital-based care strategy and the community-based care strategy for smear-positive patients (I$37 for average 5 visits) |
Sinanovic, et al. [63] | South Africa | 0.40 | 0.13 | 0.69m
| Mean cost for monitoring and collection of drugs and a clinic-based DOTS visit in Guguletu, Cape Town (95% CI I$0.20- I$0.60) |
Sinanovic, et al. [63] | South Africa | 0.30 | 0.09 | 0.52m
| Mean cost for monitoring and collection of drugs and a clinic-based DOTS visit in Nyanga, Cape Town (95% CI I$0.10- I$0.50) |
Vassall, et al. [65] | Ethiopia | 70 | 444 | 952 | Mean pretreatment transportation costs (median I$4)n
|
Wilkinson, et al. [67] | South Africa | 5 | 2 | 9 o
| Average cost of a visit to a village clinicp
|
Wilkinson, et al. [67] | South Africa | 20 | 6 | 34 o
| Average cost of a visit to a hospitalp
|
Wilkinson, et al. [67] | South Africa | 1 | 0.43 | 2 o
| Average cost of a village clinic DOTS visit, a community health worker DOTS visit, and a non-health worker DOTS visitp
|
Wyss, et al. [68] | Tanzania | 9 | 32 | 83 q
| Weekly transportation costs |
Time costs
Reported impact on income
Reported direct, indirect and total costs
Author(s) year | Country | Cost estimate (I$) | % Annual per-capita income (entire population) | % Annual per-capita income (income-poorest 20% of the population) | Notes |
---|---|---|---|---|---|
Direct costs
| |||||
Aspler, et al. [41] | Zambia | 11 | 2 | 13 | Total direct costs including medical and non-medical costs (IQR I$6- I$17) |
Datiko and Lindtjorn [48] | Ethiopia | 17 | 8 | 17 | Direct patient costs under community-based DOTS (sd I$12) |
Datiko and Lindtjorn [48] | Ethiopia | 49 | 24 | 51 | Direct patient costs under health facility-based DOTS (sd I$44) |
Kemp, et al. [54] | Malawi | 39 | 21 | 83a
| Mean total direct costs for smear-positive patients (median I$19) |
Kemp, et al. [54] | Malawi | 74 | 40 | 156a
| Mean total direct costs for smear-negative patients (median I$38) |
Mesfin, et al. [55] | Ethiopia | 114 | 60 | 129 | Mean total direct costs (median I$61; IQR I$26- I$132) |
Needham, et al. [57] | Zambia | 64 | 16 | 73 | Total mean direct costs |
Needham, et al. [58] | Zambia | 14 | 3 | 20 | Total mean direct medical costs (median I$5) |
Needham, et al. [58] | Zambia | 31 | 8 | 45 | Total mean direct non-medical costs (median I$14) |
Vassall, et al. [65] | Ethiopia | 527 | 277 | 595 | Total mean direct pretreatment costs including transport and non-transport costs for (median I$66) |
Wandwalo, et al. [66] | Tanzania | 59 | 17 | 33b
| Total direct costs under a health facility-based DOTS strategy |
Wandwalo, et al. [66] | Tanzania | 13 | 4 | 8b
| Total direct costs under a community-based DOTS strategy |
Indirect Costs
| |||||
Aspler, et al. [41] | Zambia | 21 | 5 | 25 | Median total indirect costs (IQR I$11- I$39) |
Datiko and Lindtjorn [48] | Ethiopia | 18 | 9 | 18 | Mean indirect cost under community-based DOTS |
Datiko and Lindtjorn [48] | Ethiopia | 48 | 50 | 24 | Mean indirect cost under health facility-based DOTS |
Mesfin, et al. [55] | Ethiopia | 145 | 76 | 164 | Average indirect costs from first consultation to diagnosis including income lost and travel time cost (median I$44; IQR I$15- I$101) |
Mesfin, et al. [55] | Ethiopia | 54 | 28 | 60 | Average indirect costs prior to diagnosis (median I$26.) including income last and travel time cost |
Needham, et al. [58] | Zambia | 99 | 25 | 145 | Total lost income (median I$37) |
Vassall, et al. [65] | Ethiopia | 44 | 23 | 50 | Total mean indirect pretreatment costs (median I$0) |
Wandwalo, et al. [66] | Tanzania | 56 | 16 | 32b
| Total indirect costs under a health facility-based DOTS strategy |
Wandwalo, et al. [66] | Tanzania | 19 | 5 | 11b
| Total indirect costs under a community-based DOTS strategy |
Total Costs
| |||||
Aspler, et al. [41] | Zambia | 34 | 7 | 41 | Total median costs per patients (IQR I$19-I$56) in which direct and indirect costs comprised 34% and 62%, respecitvely |
Chard, S. [46] | Uganda | 25 | 8 | 27c
| Total reported costs for biomedical treatment |
Datiko and Lindtjorn [48] | Ethiopia | 34 | 17 | 36d
| Total patient costs under community-based DOTS (sd I$16) |
Datiko and Lindtjorn [48] | Ethiopia | 99 | 48 | 104d
| Total patient costs under health facility-based DOTS (sd I$50) |
Floyd, et al. [51] | South Africa | 155 | 4 | 23e
| Total cost to patients under DOTS |
Floyd, et al. [51] | South Africa | 461 | 12 | 67e
| Total cost to patients under the conventional systemf
|
Gibson and Boillot [52] | Sierra Leone | 26 | 10 | 33g
| Total cost for patients under the National Leprosy and TB Control Program |
Mesfin, et al. [55] | Ethiopia | 259 | 136 | 292 | Mean total costs (median I$119; IQR I$53- I$242) |
Needham, et al. [58] | Zambia | 68 | 17 | 100 | Total patient costs (median I$32) |
Saunderson, P.R. [31] | Uganda | 584 | 249 | 809 | Total cost under the strategy that utilizes hospitalization for the first two months of treatment followed by an outpatient continuation phase for 4–10 months. |
Sinanovic and Kumaranayake [64] | South Africa | 102 | 3 | 17h
| Total cost per patient attending a public-non-governmental organization partnership site (95% CI I$73- I$123) |
Sinanovic and Kumaranayake [64] | South Africa | 95 | 2 | 16h
| Total cost per patient attending a public-non-governmental organization partnership site (95% CI I$82- 104) |
Sinanovic and Kumaranayake [64] | South Africa | 264 | 7 | 44h
| Total cost per patient attending a public hospital (95% CI I$251- I$274) |
Sinanovic and Kumaranayake [64] | South Africa | 317 | 8 | 53h
| Total cost per patient attending a public hospital (95% CI I$293- I$363) |
Sinanovic, et al. [63] | South Africa | 2 | 0.044 | 0.24i
| Total cost for a clinic DOTS visit, where clinic used for DOTS and total cost for monitoring/collection of drugs in Nyanga (95% CI I$1- I$2) |
Sinanovic, et al. [63] | South Africa | 2 | 0.041 | 0.23i
| Total cost for a clinic DOTS visit, where clinic used for DOTS and total cost for monitoring/collection of drugs in Guguletu (95% CI I$1- I$2) |
Sinanovic, et al. [63] | South Africa | 1 | 0.01 | 0.08i
| Total cost for a DOTS visit, where community treatment supporter u used for in Guguletu (95% CI I$1- I$2) |
Vassall, et al. [65] | Ethiopia | 567 | 298 | 639 | Total mean pretreatment costs |
Wandwalo, et al. [66] | Tanzania | 116 | 32 | 65b
| Total costs under a health facility-based DOTS strategy |
Wandwalo, et al. [66] | Tanzania | 32 | 9 | 18b
| Total costs under a community-based DOTS strategy |
Wilkinson, et al. [67] | South Africa | 183 | 5 | 27j
| Total costs for patients treated under community-based DOTS strategy. |
Caregiver and guardian costs
Catastrophic costs
Author(s) (year) | Country | Catastrophic Costs for Average Income Earners | Range (% of annual income) | Catastrophic Costs for Lowest 20% | Range (% of annual income) |
---|---|---|---|---|---|
Aspler, et al. (1998) [41] | Zambia | Total | 12 | Total, direct, indirect, pre-diagnosis, treatment, time, transportation, medication, hospitalization, direct clinic-based DOTS, indirect clinic-based DOTS | 12-40 |
Awofeso, N. (1998) [42] | Nigeria | Medication | 121 | Medication | 589 |
Bevan, E. (1997) [43] | Kenya | ___ | ___ | Medication, syringes and needles | 11-32 |
Chard, S. (2001) [46] | Uganda | Medication, traditional healer, “tipping” providers | 12-165 | Medication, traditional healer, “tipping” providers | 41-544 |
Chard, S. (2009) [47] | Uganda | Private provider, traditional healer | 47-188 | Private provider, traditional healer | 154-618 |
Datiko and Lindtjørn (2010) [48] | Ethiopia | Total, travel, time, caregiver, direct, food | 17-48 | Total, travel, time, caregiver, direct, food | 15-104 |
Floyd, et al. (2003) [50] | Malawi | Travel, hospitalization, DOTS visit | 13-262 | Travel, hospitalization | 18-1043 |
Floyd, et al. (1997) [51] | South Africa | Total, hospitalization | 11-12 | Total, hospitalization | 17-67 |
Gibson, et al. (1998) [52] | Sierra Leone | pre-program, program, hospital admission fees | 17-88 | Total, pre-program, program, hospital admission fees | 32-287 |
Harper, et al. (2003) [53] | The Gambia | Private treatment | 11 | Private treatment | 54 |
Kemp, et al. (2007) [54] | Malawi | Direct, income lost, user fees and medication, pre-diagnosis | 21-40 | Direct, income lost, user fees and medication, pre-diagnosis, food, travel | 15-155 |
Mesfin, et al. (2010) [55] | Ethiopia | Medical, non-medical, indirect, direct, medication, caregiver, total | 11-136 | Medical, non-medical, indirect, direct, medication, caregiver, travel, total | 12-292 |
Moalosi, et al. (2003) [56] | Botswana | Total caregiver costs Caregiver hospitalization Caregiver food and supplies | 13-51 | Total caregiver costs, caregiver hospitalization, caregiver medication, caregiver food and supplies | 29-258 |
Needham, et al. (1996) [57] | Zambia | Total medical, direct, income lost | 16-148 | Total medical, total non-medical, direct, income lost | 43-688 |
Needham, et al. (1998) [58] | Zambia | Total, indirect, pre-diagnosis, non-medical, food | 11-47 | Total, indirect, pre-diagnosis, non-medical, medical, food, diagnostic tests, caregiver, private provider, traditional healer, consultation fees, travel, | 15-214 |
Needham, et al. (2004) [59] | Zambia | ___ | ___ | Transportation | 11 |
Nganda, et al. (2003) [60] | Kenya | Hospitalization, travel | 33-101 | Hospitalization, travel | 22-336 |
Okello, et al. (2003) [61] | Uganda | Hospitalization, travel | 12-73 | Hospitalization, travel | 40-241 |
Saunderson, P.R. (1995) [31] | Uganda | Total, hospitalization, pre-diagnosis, indirect | 34-249 | Total, hospitalization, pre-diagnosis, indirect | 111-809 |
Sinanovic, et al. (2003) [63] | South Africa | ___ | ___ | Total | 11-43 |
Sinanovic and Kumaranay-ake (2006) [64] | South Africa | ___ | ___ | Total, time, travel | 11-53 |
Vassall, et al. (2010) [65] | Ethiopia | Direct, indirect, travel and total pretreatment | 23-298 | Direct, indirect, travel and total pretreatment | 50-639 |
Wandwalo, et al. (2005) [66] | Tanzania | Total, direct, indirect | 16-32 | Total, direct, indirect | 18-65 |
Wilkinson, et al. (1997) [67] | South Africa | ___ | ___ | Total, hospitalization | 20-27 |
Wyss, et al. (2001) [68] | Tanzania | Private provider | 12 | Traditional healer, private provider, hospitalization | 10-29 |