Tuberc Respir Dis > Accepted Articles
DOI: https://doi.org/10.4046/trd.2021.0028    [Accepted]
Published online September 3, 2021.
Assessment of Household Catastrophic Total Cost of Tuberculosis and Its Determinants in Cairo; Prospective Cohort Study
Manar M. Ellaban  , Nashwa I Basyoni, Dina N.K. Boulos, Mervat Rady, Mohsen Gadallah
Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University
Correspondence:  Manar M. Ellaban, Tel: +20-1550690740, Fax: +20224346041, 
Email: Manarellaban@med.asu.edu.eg
Received: 16 February 2021   • Revised: 25 April 2021   • Accepted: 1 September 2021
Abstract
Background
One goal of the End TB Strategy is to see no tuberculosis (TB) affected households experiencing catastrophic costs. Therefore, it is crucial for TB elimination programs to identify catastrophic costs and their main drivers to establish appropriate health and social measures.
Objectives
To measure the percentage of catastrophic costs experienced by Egyptian TB patients and to identify its determinants.
Methods
A prospective cohort study was conducted with 151 Egyptian TB patients recruited from two chest dispensaries from the Cairo governorate starting from May 2019 until May 2020. A validated WHO TB patient cost tool was used to collect data on patients’ demographic information, household income, and direct and indirect expense of seeking TB treatment. We considered catastrophic TB costs to be total costs exceeding 20% of the household’s annual income.
Results
Of the patients, 33% experienced catastrophic costs. The highest proportion of total came in the pre-treatment stage. Being the main breadwinner, experiencing job loss, selling property, and the occurrence of early COVID-19 lockdown were independent determinants of the incidence of catastrophic costs. Borrowing money and selling property were the most-often reported coping strategies adopted.
Conclusion
Despite the availability of free TB care under the Egyptian National TB Program, nearly one-third of the TB patients incurred catastrophic costs. Job loss and being the main breadwinner were among the significant predictors of catastrophic costs.
Recommendation
Social protection mechanisms, including cash assistance and insurance coverage, are necessary to achieve the goal of the End TB Strategy.
Key Words: Tuberculosis, Catastrophic Costs, Determinants, Coping
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ORCID iDs

Manar M. Ellaban
https://orcid.org/0000-0001-5612-5513

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