Defining Catastrophic Costs and Comparing Their Importance for Adverse Tuberculosis Outcome with Multi-Drug Resistance

A Prospective Cohort Study, Peru

Tom Wingfield, Delia Boccia, Marco Tovar, Arquímedes Gavino, Karine Zevallos, Rosario Montoya, Knut Lönnroth, Carlton A. Evans

Research output: Contribution to journalArticle

Abstract

Background:Even when tuberculosis (TB) treatment is free, hidden costs incurred by patients and their households (TB-affected households) may worsen poverty and health. Extreme TB-associated costs have been termed "catastrophic" but are poorly defined. We studied TB-affected households' hidden costs and their association with adverse TB outcome to create a clinically relevant definition of catastrophic costs.Methods and Findings:From 26 October 2002 to 30 November 2009, TB patients (n = 876, 11% with multi-drug-resistant [MDR] TB) and healthy controls (n = 487) were recruited to a prospective cohort study in shantytowns in Lima, Peru. Patients were interviewed prior to and every 2-4 wk throughout treatment, recording direct (household expenses) and indirect (lost income) TB-related costs. Costs were expressed as a proportion of the household's annual income. In poorer households, costs were lower but constituted a higher proportion of the household's annual income: 27% (95% CI = 20%-43%) in the least-poor houses versus 48% (95% CI = 36%-50%) in the poorest. Adverse TB outcome was defined as death, treatment abandonment or treatment failure during therapy, or recurrence within 2 y. 23% (166/725) of patients with a defined treatment outcome had an adverse outcome. Total costs ≥20% of household annual income was defined as catastrophic because this threshold was most strongly associated with adverse TB outcome. Catastrophic costs were incurred by 345 households (39%). Having MDR TB was associated with a higher likelihood of incurring catastrophic costs (54% [95% CI = 43%-61%] versus 38% [95% CI = 34%-41%], p

Original languageEnglish (US)
Article numbere1001675
JournalPLoS Medicine
Volume11
Issue number7
DOIs
StatePublished - 2014
Externally publishedYes

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Peru
Multiple Drug Resistance
Tuberculosis
Cohort Studies
Prospective Studies
Costs and Cost Analysis
Multidrug-Resistant Tuberculosis
Therapeutics
Poverty
Treatment Failure
Recurrence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Defining Catastrophic Costs and Comparing Their Importance for Adverse Tuberculosis Outcome with Multi-Drug Resistance : A Prospective Cohort Study, Peru. / Wingfield, Tom; Boccia, Delia; Tovar, Marco; Gavino, Arquímedes; Zevallos, Karine; Montoya, Rosario; Lönnroth, Knut; Evans, Carlton A.

In: PLoS Medicine, Vol. 11, No. 7, e1001675, 2014.

Research output: Contribution to journalArticle

Wingfield, Tom ; Boccia, Delia ; Tovar, Marco ; Gavino, Arquímedes ; Zevallos, Karine ; Montoya, Rosario ; Lönnroth, Knut ; Evans, Carlton A. / Defining Catastrophic Costs and Comparing Their Importance for Adverse Tuberculosis Outcome with Multi-Drug Resistance : A Prospective Cohort Study, Peru. In: PLoS Medicine. 2014 ; Vol. 11, No. 7.
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T2 - A Prospective Cohort Study, Peru

AU - Wingfield, Tom

AU - Boccia, Delia

AU - Tovar, Marco

AU - Gavino, Arquímedes

AU - Zevallos, Karine

AU - Montoya, Rosario

AU - Lönnroth, Knut

AU - Evans, Carlton A.

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