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Volume 26, Number 5—May 2020

Pretreatment Out-of-Pocket Expenses for Presumptive Multidrug-Resistant Tuberculosis Patients, India, 2016–2017

Priya RathiComments to Author , Kalpita Shringarpure, Bhaskaran Unnikrishnan, Vineet Kumar Chadha, Vishak Acharya, Abirami Nair, Karuna D. Sagili, and Suresh Shastri
Author affiliations: Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India (P. Rathi, B. Unnikrishnan, V. Acharya, A. Nair); Medical College Baroda, Baroda, India (K. Shringarpure); Central Leprosy Teaching and Research Institute, Tamil Nadu, India (V.K. Chadha); National Tuberculosis Institute, Epidemiology and Research, Division Bengaluru, India (V.K. Chadha); International Union against Tuberculosis and Lung Disease, South East Asia Office, New Delhi, India (K.D. Sagili); Lady Willington State TB Centre, Bengaluru (S. Shastri)

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Table 2

Median disaggregated costs incurred by 40 patients (households) from the stage of presumptive MDR TB to pre-MDR TB treatment evaluation, India, August 2016–April 2017*

Cost category Median (IQR), USD
Total income
608.00 (228.00–912.00)
Total direct medical costs†
37.44 (7.10–198.24)
Total diagnosis, n = 38
01.58 (0.30–2.40)
Total investigation, n = 36
17.70 (3.19–60.27)
Total treatment, n = 26
15.07 (11.30–47.08)
Total admission, n = 15
45.20 (30.13–75.34)
Total direct nonmedical costs‡
51.20 (28.00–85.36)
Total food, n = 38
35.41 (18.08–64.97)
Total travel, n = 39
12.84 (5.73–12.84)
Total accommodations, n = 1
36.16 (36.16–36.16)
Additional nutrition, n = 38
01.51 (0.75–3.77)
Total direct costs§
105.12 (48.75–306)
Total indirect costs, n = 18¶
51.20 (1.60–306.00)
Total expenditures#
171.31 (72.00–432.00)
Total coping costs 640.00 (324.00–1,360)

*Because all patients did not incur all categories of costs, n differs for different categories. Median (IQR) is calculated only for those who incurred a given cost. IQR, interquartile range; MDR TB, multidrug-resistant TB; TB, tuberculosis: USD, US dollars.
†Direct medical costs = sum of diagnosis investigation (general investigation and disease-specific investigations), complete blood count, erythrocyte sedimentation rate, liver function testing, renal function testing, spirometry, computed tomography, magnetic resonance imaging. Disease specific cost = sputum-smear microscopy, culture, drug-susceptibility testing, radiography, drugs, and hospitalization.
‡Direct nonmedical costs = sum of food, accommodation, travel by both patient and attendant.
§Direct costs = sum of total direct medical costs and total direct nonmedical costs.
¶Indirect costs = loss of wages for patient and attendant during the visit.
#Total expenditure = sum of total direct and total indirect costs.

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Page created: April 16, 2020
Page updated: April 16, 2020
Page reviewed: April 16, 2020
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