St Andrews Research Repository

St Andrews University Home
View Item 
  •   St Andrews Research Repository
  • University of St Andrews Research
  • University of St Andrews Research
  • University of St Andrews Research
  • View Item
  •   St Andrews Research Repository
  • University of St Andrews Research
  • University of St Andrews Research
  • University of St Andrews Research
  • View Item
  •   St Andrews Research Repository
  • University of St Andrews Research
  • University of St Andrews Research
  • University of St Andrews Research
  • View Item
  • Login
JavaScript is disabled for your browser. Some features of this site may not work without it.

The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

Thumbnail
View/Open
Gurung_2019_IDP_Activecase_CC.pdf (887.3Kb)
Date
03/12/2019
Author
Gurung, Suman Chandra
Dixit, Kritika
Rai, Bhola
Caws, Maxine
Paudel, Puskar Raj
Dhital, Raghu
Acharya, Shraddha
Budhathoki, Gangaram
Malla, Deepak
Levy, Jens W.
van Rest, Job
Lönnroth, Knut
Viney, Kerri
Ramsay, Andrew
Wingfield, Tom
Basnyat, Buddha
Thapa, Anil
Squire, Bertie
Wang, Duolao
Mishra, Gokul
Shah, Kashim
Shrestha, Anil
de Siqueira-Filha, Noemia Teixeira
Keywords
Tuberculosis
Case finding
Catastrophic cost
Patient-incurred cost
Nepal
RA0421 Public health. Hygiene. Preventive Medicine
E-DAS
Metadata
Show full item record
Altmetrics Handle Statistics
Altmetrics DOI Statistics
Abstract
Background The World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal. Methods The study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income. The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis. Results Ninety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32, P = 0.001; direct non-medical: USD 3 vs USD 10, P = 0.004; indirect, time loss: USD 4 vs USD 13, P <  0.001). The cost of the pre-treatment and intensive phases combined was also lower for direct medical (USD 15 vs USD 34, P = 0.002) and non-medical (USD 30 vs USD 54, P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant. Conclusions ACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.
Citation
Gurung , S C , Dixit , K , Rai , B , Caws , M , Paudel , P R , Dhital , R , Acharya , S , Budhathoki , G , Malla , D , Levy , J W , van Rest , J , Lönnroth , K , Viney , K , Ramsay , A , Wingfield , T , Basnyat , B , Thapa , A , Squire , B , Wang , D , Mishra , G , Shah , K , Shrestha , A & de Siqueira-Filha , N T 2019 , ' The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal ' , Infectious Diseases of Poverty , vol. 8 , 99 . https://doi.org/10.1186/s40249-019-0603-z
Publication
Infectious Diseases of Poverty
Status
Peer reviewed
DOI
https://doi.org/10.1186/s40249-019-0603-z
ISSN
2049-9957
Type
Journal article
Rights
Copyright © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Description
Stop TB Partnership/UNOPS – TB REACH project (grant number: 5–31); European Union, Horizon 2020 – IMPACT TB project (grant number: 733174).
Collections
  • University of St Andrews Research
URI
http://hdl.handle.net/10023/19084

Items in the St Andrews Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.

Advanced Search

Browse

All of RepositoryCommunities & CollectionsBy Issue DateNamesTitlesSubjectsClassificationTypeFunderThis CollectionBy Issue DateNamesTitlesSubjectsClassificationTypeFunder

My Account

Login

Open Access

To find out how you can benefit from open access to research, see our library web pages and Open Access blog. For open access help contact: openaccess@st-andrews.ac.uk.

Accessibility

Read our Accessibility statement.

How to submit research papers

The full text of research papers can be submitted to the repository via Pure, the University's research information system. For help see our guide: How to deposit in Pure.

Electronic thesis deposit

Help with deposit.

Repository help

For repository help contact: Digital-Repository@st-andrews.ac.uk.

Give Feedback

Cookie policy

This site may use cookies. Please see Terms and Conditions.

Usage statistics

COUNTER-compliant statistics on downloads from the repository are available from the IRUS-UK Service. Contact us for information.

© University of St Andrews Library

University of St Andrews is a charity registered in Scotland, No SC013532.

  • Facebook
  • Twitter