Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

• Main Authors: Hemant Deepak Shewade, Vivek Gupta, Srinath Satyanarayana, Atul Kharate, K.N. Sahai, Lakshmi Murali, Sanjeev Kamble, Madhav Deshpande, Naresh Kumar, Sunil Kumar, Prabhat Pandey, U.N. Bajpai, Jaya Prasad Tripathy, Soundappan Kathirvel, Sripriya Pandurangan, Subrat Mohanty, Vaibhav Haribhau Ghule, Karuna D. Sagili, Banuru Muralidhara Prasad, Sudhi Nath, Priyanka Singh, Kamlesh Singh, Ramesh Singh, Gurukartick Jayaraman, P. Rajeswaran, Binod Kumar Srivastava, Moumita Biswas, Gayadhar Mallick, Om Prakash Bera, A. James Jeyakumar Jaisingh, Ali Jafar Naqvi, Prafulla Verma, Mohammed Salauddin Ansari, Prafulla C. Mishra, G. Sumesh, Sanjeeb Barik, Vijesh Mathew, Manas Ranjan Singh Lohar, Chandrashekhar S. Gaurkhede, Ganesh Parate, Sharifa Yasin Bale, Ishwar Koli, Ashwin Kumar Bharadwaj, G. Venkatraman, K. Sathiyanarayanan, Jinesh Lal, Ashwini Kumar Sharma, Raghuram Rao, Ajay M.V. Kumar, Sarabjit Singh Chadha
• Format: Article
• Language: English
• Published: Taylor & Francis Group 2018-01-01
• Series: Global Health Action
• Subjects: tuberculosis/prevention and control; systematic screening; vulnerable populations; health care costs; health equity
• Online Access: http://dx.doi.org/10.1080/16549716.2018.1494897
• ISSN: 1654-9716; 1654-9880

Background: There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. Objectives: To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). Methods: In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as ‘catastrophic’ if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. Results: When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US$ 4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF [−0.15 (−0.32, 0.11)] and PCF [−0.06 (−0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [−0.60 (−0.81, –0.39)] and PCF [−0.58 (−0.78, –0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles. Conclusion: ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity.