Abstract:

Objective To understand the diagnosis and treatment costs for patients with rifampicin-resistant pulmonary tuberculosis in order to provide references for development or adjustment of the policies for this population group. Methods By stratified sampling and convenience sampling methods, we initially selected 6, 3 and 5 provinces from the eastern, central and western regions of China, respectively. Then one or two cities with higher degree of work cooperation was/were singled out from each province, and one designated medical institution with effective work cooperation was selected from each city for the survey. A questionnaire survey was conducted among rifampicin-resistant pulmonary tuberculosis patients who were treated from January to June 2021, and the economic burden of disease was analyzed. Results In this study, 162 patients underwent the survey. The mean total cost from the onset of symptoms to the completion of treatment was 109 452 (69 530, 182 365) yuan, of which the direct medical cost was 88 681 (58 967, 160 611) yuan, and the direct non-medical cost was 10 299 (4 710, 19 029) yuan. The mean indirect cost was 974 (0, 4 380) yuan. Self-paid expense was 68 052 (44 597, 93 761) yuan, with the proportion of individual payment being 63.78% (43.79%, 81.07%). The proportion of individual payment for direct medical expenses was 54.88% (36.10%, 78.21%), and the proportion was higher in western region [71.35% (48.78%, 96.10%)] and non-hospitalized patients [90.23% (65.90%, 100.00%)] (H=35.061, Z=38.650; all P <0.01). The incidence of catastrophic health expenditure of patients’ families was 96.25%. There were significant differences in the proportion of total out-of-pocket expenses in annual household income among patients with different education levels, occupations, regions, whether they were from families with the highest household income, or whether they were floating population (H=21.536, 38.579, 11.439; Z=2.931, -3.830; all P <0.01). The results of multivariate analysis showed that farmers (b=2.395, 95%CI: 1.249-3.541) and housework and unemployment (b=2.324, 95%CI: 0.753-3.894) were the risk factors for increased economic burden of patients compared with students and teachers. Conclusion The economic burden of patients with rifampicin-resistant pulmonary tuberculosis in China is relatively heavy, especially the direct medical expenses are relatively high. Meanwhile, special attention should be paid to the economic burden of such tuberculosis victims as farmers, domestic workers and the unemployed.

Key words: Drug-resistant pulmonary tuberculosis, Rifampicin, Medical treatment expenses, Economic burden