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dc.contributor.authorGurung, Suman Chandra
dc.contributor.authorRai, Bhola
dc.contributor.authorDixit, Kritika
dc.contributor.authorWorrall, Eve
dc.contributor.authorPaudel, Puskar Raj
dc.contributor.authorDhital, Raghu
dc.contributor.authorSah, Manoj Kumar
dc.contributor.authorPandit, Ram Narayan
dc.contributor.authorAryal, Tara Prasad
dc.contributor.authorMajhi, Govinda
dc.contributor.authorWingfield, Tom
dc.contributor.authorSquire, Bertie
dc.contributor.authorLönnroth, Knut
dc.contributor.authorLevy, Jens W
dc.contributor.authorViney, Kerri
dc.contributor.authorvan Rest, Job
dc.contributor.authorRamsay, Andrew
dc.contributor.authorSantos da Costa, Rafaely Marcia
dc.contributor.authorBasnyat, Buddha
dc.contributor.authorThapa, Anil
dc.contributor.authorMishra, Gokul
dc.contributor.authorMoreira Pescarini, Julia
dc.contributor.authorCaws, Maxine
dc.contributor.authorTeixeira de Siqueira-Filha, Noemia
dc.date.accessioned2021-06-16T15:30:14Z
dc.date.available2021-06-16T15:30:14Z
dc.date.issued2021-06-03
dc.identifier274658283
dc.identifier1cf39522-5d87-4a2a-91a5-fccf3a0dfe76
dc.identifier85107711455
dc.identifier000728176700002
dc.identifier.citationGurung , S C , Rai , B , Dixit , K , Worrall , E , Paudel , P R , Dhital , R , Sah , M K , Pandit , R N , Aryal , T P , Majhi , G , Wingfield , T , Squire , B , Lönnroth , K , Levy , J W , Viney , K , van Rest , J , Ramsay , A , Santos da Costa , R M , Basnyat , B , Thapa , A , Mishra , G , Moreira Pescarini , J , Caws , M & Teixeira de Siqueira-Filha , N 2021 , ' How to reduce household costs for people with tuberculosis : a longitudinal costing survey in Nepal ' , Health Policy and Planning , vol. 36 , no. 5 , pp. 594-605 . https://doi.org/10.1093/heapol/czaa156en
dc.identifier.issn1460-2237
dc.identifier.otherJisc: b889e1d85ce84e9e9e988ae3614fcd64
dc.identifier.urihttps://hdl.handle.net/10023/23373
dc.descriptionThe study was supported by European Union Horizon2020 [grant number 733174: IMPACT TB].en
dc.description.abstractThe aim of this study was to compare costs and socio-economic impact of tuberculosis (TB) for patients diagnosed through active (ACF) and passive case finding (PCF) in Nepal. A longitudinal costing survey was conducted in four districts of Nepal from April 2018 to October 2019. Costs were collected using the WHO TB Patient Costs Survey at three time points: intensive phase of treatment, continuation phase of treatment and at treatment completion. Direct and indirect costs and socio-economic impact (poverty headcount, employment status and coping strategies) were evaluated throughout the treatment. Prevalence of catastrophic costs was estimated using the WHO threshold. Logistic regression and generalized estimating equation were used to evaluate risk of incurring high costs, catastrophic costs and socio-economic impact of TB over time. A total of 111 ACF and 110 PCF patients were included. ACF patients were more likely to have no education (75% vs 57%, P = 0.006) and informal employment (42% vs 24%, P = 0.005) Compared with the PCF group, ACF patients incurred lower costs during the pretreatment period (mean total cost: US$55 vs US$87, P < 0.001) and during the pretreatment plus treatment periods (mean total direct costs: US$72 vs US$101, P < 0.001). Socio-economic impact was severe for both groups throughout the whole treatment, with 32% of households incurring catastrophic costs. Catastrophic costs were associated with ‘no education’ status [odds ratio = 2.53(95% confidence interval = 1.16–5.50)]. There is a severe and sustained socio-economic impact of TB on affected households in Nepal. The community-based ACF approach mitigated costs and reached the most vulnerable patients. Alongside ACF, social protection policies must be extended to achieve the zero catastrophic costs milestone of the End TB strategy.
dc.format.extent12
dc.format.extent633117
dc.language.isoeng
dc.relation.ispartofHealth Policy and Planningen
dc.subjectTuberculosisen
dc.subjectCase findingen
dc.subjectCostsen
dc.subjectCatastrophic costsen
dc.subjectNepalen
dc.subjectHV Social pathology. Social and public welfareen
dc.subjectRA Public aspects of medicineen
dc.subjectE-DASen
dc.subjectSDG 1 - No Povertyen
dc.subjectSDG 3 - Good Health and Well-beingen
dc.subjectSDG 8 - Decent Work and Economic Growthen
dc.subjectSDG 10 - Reduced Inequalitiesen
dc.subject.lccHVen
dc.subject.lccRAen
dc.titleHow to reduce household costs for people with tuberculosis : a longitudinal costing survey in Nepalen
dc.typeJournal articleen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.contributor.institutionUniversity of St Andrews. Infection and Global Health Divisionen
dc.identifier.doi10.1093/heapol/czaa156
dc.description.statusPeer revieweden


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