Cost analysis of tuberculosis treatment in two tertiary hospitals in South-East Nigeria

Abstract

Background: Treatment of tuberculosis is known to be free of charge to patients in Nigeria. How free is it? Several governmental and non-governmental agencies support tuberculosis treatment to make the services accessible and affordable to patients. These efforts are geared towards reducing the burden of the disease in the community.
Objective: To estimate the pattern and overall costs incurred by the patients and to compare the cost of tuberculosis treatment in these two centers.
Methodology: A descriptive cross-sectional study among tuberculosis patients, who came for treatment in these centers, was done using a pre-coded, pre-tested questionnaire between 1^st October and 1^st December, 2012. Information was collected on demographic, socioeconomic characteristics and expenditure before and during treatment. Data were analyzed and presented as mean costs which were used for comparison.
Results: The overall estimated average direct costs were between N71, 575.61 [$436.44] (4.83% of income) and N108, 567.31 [$663.00] (63.3%), average indirect cost was between N112, 602.75 [$686.60] (41.3%) and N216, 624.83 [$1320.88] (59.1%), average coping cost was between N18, 670.56 [$113.84] (4.4%) and N48, 104.17 [$293.32] (52.2%), and overall total cost was between N244, 265.76 [$1489.43] (91.5%) and N363, 814.66 [$2218.38] (133.1%).
The mean direct cost incurred was found to be N81, 287.63 ($495.66) in those who come on an out-patient basis to these two tertiary health facilities and N129, 450 ($789.33) in patients admitted in Federal Medical  Centre Umuahia. In the same vein, the mean indirect cost incurred was found to be N165, 026.32 ($1,006.25) in those who come on an out-patient basis to these two institutions and N163, 000 ($993.90) in patients admitted in Federal Medical Centre, Umuahia, while their mean total cost was found to be N291, 563.95 ($1,777.83) in those who come on an out-patient basis to these centres and N351, 450 ($2,142.99) in patients admitted in Federal Medical Centre, Umuahia. All the cost incurred by patients admitted in Federal Medical Centre was found to be highest. It was also observed that there is a difference in cost incurred by patients who come on an out-patient basis to these institutions as compared to those on admission.
Conclusion: This study has brought to light the financial burden of tuberculosis care on patients and their families and therefore emphasized the need for the review of cost reduction by the relevant stakeholders and policy makers. This will help to increase the access of tuberculosis care to the poor and unreached populations, thereby achieving universal access to tuberculosis care. It has also highlighted the variation in cost among the different treatment modalities.

Keywords: Home-based care, Hospital-based care, Directly Observed Therapy (DOT), Cost