These are uniquely challenging times in the fight against the enduring and accelerating scourge of tuberculosis (TB) – an airborne illness caused by bacteria that kills more people than any other infectious disease despite the fact it’s preventable and curable.
The COVID-19 pandemic caused a serious setback in TB progress as health resources were diverted. And now, the slashing of foreign aid by the U.S. government, which had largely propped up international TB prevention and treatment efforts, threatens to hobble access to care for this chronic disease and provide new chances for TB to propagate and spread drug resistance.
The result: Millions of people – especially the world’s most vulnerable - are more at risk.
Now, a collaborative studyled by a uOttawa Faculty of Medicine team guided by an epidemiologist and health economist is sounding the alarm about the “catastrophic costs” of TB care. Summarizing current evidence, the new work says that although many countries offer free treatment for TB, many patients suffering from TB are still shelling out punishing out-of-pocket costs.
Led by senior author Dr. Alice Zwerling, Associate Professor at the uOttawa Faculty of Medicine’s School of Epidemiology and Public Health, the international team’s work is a systematic review intended to help inform decisions on patient burden and cost-effective care for tuberculosis.
For government policymakers and public health leaders, systematic reviews like this new collaboration are a critical component in the fight against this chronic disease because TB research, treatment and prevention programs are so cash-strapped and the investments required are considerable. Known as a disease of poverty, the ancient illness is caused by a bacterium, Mycobacterium tuberculosis, that infects the lungs and is highly transmissible when infected people cough or sneeze.
The uOttawa-led review – which included 76 studies, all but one conducted in low- or middle-income countries – was published today by Plos Global Public Health, an open-access global forum for impactful public health research. The journal’s press team selected the paper for a special highlight and featured it in a media outreach effort.
Here’s one of the study’s cost breakdowns: For drug-resistant tuberculosis (DR-TB) patients, the average total cost of TB care is a mean of $3,617. For drug-sensitive tuberculosis (DS-TB) patients, the average total cost is a mean of $1,083. These are indeed “catastrophic” costs in many parts of the world, representing more than 80% of the households’ monthly income.
“Despite the availability of free TB treatment, patients continue to experience large out-of-pocket expenditures leading to economic instability. Improving access to drug resistance testing and implementing more active case finding approaches in the community could significantly reduce catastrophic costs incurred by TB patients,” Dr. Zwerling says.
She says the free costs of TB care in swaths of the globe can often lead to misunderstanding and the underestimation of true-out-of-pocket expenditures for patients. For example, Dr. Zwerling says lost wages experienced by TB patients due to hospitalization or required isolation during lengthy diagnostic or treatments pathways can have a “devastating impact” on a household’s finances.
“As services are further withdrawn due to funding challenges in the current political climate, these pathways will only become more lengthy, convoluted and costly for TB patients seeking care, likely leading to more delayed diagnosis and treatment, ongoing community transmission and negative societal economic impacts,” she says.
How might this timely review help policymakers and healthcare providers develop sustainable TB mitigation strategies? The work identifies several areas for intervention to reduce and avert patient costs as outlined in the World Health Organization’s “End TB Strategy.”
Dr. Zwerling says these include prioritizing active case finding which will also serve to potentially reduce ongoing transmission in the community and improve case notification rates and improving access to drug resistance testing for which there are a number of promising new alternatives.
Next, the collaborative team hopes to conduct similar patient cost surveys to understand the burden of TB patient costs in northern Canada’s Nunavut and areas of sub-Saharan Africa.