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Household catastrophic total cost due to tuberculosis in Egypt: incidence, cost drivers and policy implication.

Background
Tuberculosis (TB) is a disease that disproportionately affects the poor. The World Health Organization lists economic factors as one of main barriers to tuberculosis management.


Aims
This study aimed to estimate the household total catastrophic cost of TB and its determinants among newly diagnosed Egyptian tuberculous patients.


Methods
This was a cohort prospective study covering 257 TB patients registered in 2019. The patients were followed up bi-monthly until the end of the treatment regimen (4 visits). A standardized questionnaire published by the poverty sub-working group of the Stop TB Partnership was used after minor modification. The following costs were measured: pre-diagnosis, direct and indirect, guardian and coping, as well as annual household income. Catastrophic cost (direct plus indirect) was considered if the total cost of TB treatment exceeded 20% of the household's annual income. Sensitivity analyses were conducted using different thresholds.


Results
The incidence of household total catastrophic cost was 24.1%. The mean total cost of TB treatment was US$ 198. Over 50% of the total direct cost was incurred during the pre-diagnosis period. After adjustment for other determinant variables using multivariable logistic regression, we found that age < 30 years, living in a house with crowding index > 2, poverty and coping were more likely to cause higher total catastrophic cost.


Conclusions
Catastrophic cost was experienced by 1 out of every 4 new TB patients. As the main cost drivers were poverty and coping, the Ministry of Health and Population should be collaborated with Ministry of Finance and NGOs to put a plan of social protection system for poor families with TB patients.