Elsevier

Social Science & Medicine

Volume 130, April 2015, Pages 42-50
Social Science & Medicine

The economic burden of TB diagnosis and treatment in South Africa

https://doi.org/10.1016/j.socscimed.2015.01.046Get rights and content
Under a Creative Commons license
open access

Highlights

  • The greatest economic burden on patients is during the symptomatic period.

  • Indirect costs make up more than half of the total episode costs.

  • Access to government grants only occur during the continuation phase of treatment.

  • Broader social protection strategies needed to prevent poverty due to illness.

Abstract

Social protection against the cost of illness is a central policy objective of Universal Health Coverage and the post-2015 Global strategy for Tuberculosis (TB). Understanding the economic burden associated with TB illness and care is key to identifying appropriate interventions towards achieving this target. The aims of this study were to identify points in patient pathways from start of TB symptoms to treatment completion where interventions could be targeted to reduce the economic impact on patients and households, and to identify those most vulnerable to these costs.

Two cohorts of patients accessing TB services from ten clinics in four provinces in South Africa were surveyed between July 2012 and June 2013. One cohort of 351 people with suspected TB were interviewed at the point of receiving a TB diagnostic and followed up six months later. Another cohort of 168 patients on TB treatment, at the same ten facilities, was interviewed at two-months and five-months on treatment. Patients were asked about their health-seeking behaviour, associated costs, income loss, and coping strategies used.

Patients incurred the greatest share of TB episode costs (41%) prior to starting treatment, with the largest portion of these costs being due to income loss. Poorer patients incurred higher direct costs during treatment than those who were less poor but only 5% of those interviewed were accessing cash-transfers during treatment. Indirect costs accounted for 52% of total episode cost.

Despite free TB diagnosis and care in South Africa, patients incur substantial direct and indirect costs particularly prior to starting treatment. The poorest group of patients were incurring higher costs, with fewer resources to pay for it. Both the direct and indirect cost of illness should be taken into account when setting levels of financial protection and social support, to prevent TB illness from pushing the poor further into poverty.

Keywords

South Africa
Patient costs
Tuberculosis
Costing
Diagnosis
Treatment
Catastrophic costs
Economic burden

Cited by (0)