PMID- 38042797
OWN - NLM
STAT- MEDLINE
DCOM- 20231204
LR  - 20240116
IS  - 1471-2458 (Electronic)
IS  - 1471-2458 (Linking)
VI  - 23
IP  - 1
DP  - 2023 Dec 3
TI  - Determinants of catastrophic costs among households affected by multi-drug 
      resistant tuberculosis in Ho Chi Minh City, Viet Nam: a prospective cohort study.
PG  - 2372
LID - 10.1186/s12889-023-17078-5 [doi]
LID - 2372
AB  - BACKGROUND: Globally, most people with multidrug-resistant tuberculosis (MDR-TB) 
      and their households experience catastrophic costs of illness, diagnosis, and 
      care. However, the factors associated with experiencing catastrophic costs are 
      poorly understood. This study aimed to identify risk factors associated with 
      catastrophic costs incurrence among MDR-TB-affected households in Ho Chi Minh 
      City (HCMC), Viet Nam. METHODS: Between October 2020 and April 2022, data were 
      collected using a locally-adapted, longitudinal WHO TB Patient Cost Survey in ten 
      districts of HCMC. Ninety-four people with MDR-TB being treated with a nine-month 
      TB regimen were surveyed at three time points: after two weeks of treatment 
      initiation, completion of the intensive phase and the end of the treatment 
      (approximately five and 10 months post-treatment initiation respectively). The 
      catastrophic costs threshold was defined as total TB-related costs exceeding 20% 
      of annual pre-TB household income. Logistic regression was used to identify 
      variables associated with experiencing catastrophic costs. A sensitivity analysis 
      examined the prevalence of catastrophic costs using alternative thresholds and 
      cost estimation approaches. RESULTS: Most participants (81/93 [87%]) experienced 
      catastrophic costs despite the majority 86/93 (93%) receiving economic support 
      through existing social protection schemes. Among participant households 
      experiencing and not experiencing catastrophic costs, median household income was 
      similar before MDR-TB treatment. However, by the end of MDR-TB treatment, median 
      household income was lower (258 [IQR: 0-516] USD vs. 656 [IQR: 462-989] USD; 
      p = 0.003), and median income loss was higher (2838 [IQR: 1548-5418] USD vs. 301 
      [IQR: 0-824] USD; p < 0.001) amongst the participant households who experienced 
      catastrophic costs. Being the household's primary income earner before MDR-TB 
      treatment (aOR = 11.2 [95% CI: 1.6-80.5]), having a lower educational level 
      (aOR = 22.3 [95% CI: 1.5-344.1]) and becoming unemployed at the beginning of 
      MDR-TB treatment (aOR = 35.6 [95% CI: 2.7-470.3]) were associated with 
      experiencing catastrophic costs. CONCLUSION: Despite good social protection 
      coverage, most people with MDR-TB in HCMC experienced catastrophic costs. 
      Incurrence of catastrophic costs was independently associated with being the 
      household's primary income earner or being unemployed. Revision and expansion of 
      strategies to mitigate TB-related catastrophic costs, in particular avoiding 
      unemployment and income loss, are urgently required.
CI  - (c) 2023. The Author(s).
FAU - Pham, Thi Anh Mai
AU  - Pham TAM
AD  - WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of 
      Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
FAU - Forse, Rachel
AU  - Forse R
AUID- ORCID: 0000-0002-0716-3342
AD  - WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of 
      Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden. 
      rachel.forse@tbhelp.org.
AD  - Friends for International TB Relief, 1/21 Le Van Luong, Nhan Chinh, Thanh Xuan, 
      Ha Noi, Viet Nam. rachel.forse@tbhelp.org.
FAU - Codlin, Andrew J
AU  - Codlin AJ
AD  - WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of 
      Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
AD  - Friends for International TB Relief, 1/21 Le Van Luong, Nhan Chinh, Thanh Xuan, 
      Ha Noi, Viet Nam.
FAU - Phan, Thi Hoang Yen
AU  - Phan THY
AD  - Centre for Development of Community Health Initiatives, 1/21 Le Van Luong, Nhan 
      Chinh, Thanh Xuan, Ha Noi, Viet Nam.
FAU - Nguyen, Thanh Thi
AU  - Nguyen TT
AD  - Centre for Development of Community Health Initiatives, 1/21 Le Van Luong, Nhan 
      Chinh, Thanh Xuan, Ha Noi, Viet Nam.
FAU - Nguyen, Nga
AU  - Nguyen N
AD  - Friends for International TB Relief, 1/21 Le Van Luong, Nhan Chinh, Thanh Xuan, 
      Ha Noi, Viet Nam.
FAU - Vo, Luan Nguyen Quang
AU  - Vo LNQ
AD  - Centre for Development of Community Health Initiatives, 1/21 Le Van Luong, Nhan 
      Chinh, Thanh Xuan, Ha Noi, Viet Nam.
FAU - Dat, Phan Thuong
AU  - Dat PT
AD  - Pham Ngoc Thach Hospital, 120 Hong Bang, Ward12, District 5, Ho Chi Minh City, 
      Viet Nam.
FAU - Minh, Ha Dang Thi
AU  - Minh HDT
AD  - Pham Ngoc Thach Hospital, 120 Hong Bang, Ward12, District 5, Ho Chi Minh City, 
      Viet Nam.
FAU - Nguyen, Lan Huu
AU  - Nguyen LH
AD  - Pham Ngoc Thach Hospital, 120 Hong Bang, Ward12, District 5, Ho Chi Minh City, 
      Viet Nam.
FAU - Nguyen, Hoa Binh
AU  - Nguyen HB
AD  - National Lung Hospital/National TB Control Programme, 463 Hoang Hoa Tham, Vinh 
      Phu, Ba Dinh, Ha Noi, Viet Nam.
FAU - Nguyen, Nhung Viet
AU  - Nguyen NV
AD  - National Lung Hospital/National TB Control Programme, 463 Hoang Hoa Tham, Vinh 
      Phu, Ba Dinh, Ha Noi, Viet Nam.
AD  - University of Medicine and Pharmacy, Vietnam National University, Ha Noi, Viet 
      Nam.
FAU - Bodfish, Miranda
AU  - Bodfish M
AD  - CDC Foundation, 600 Peachtree Street NE, Suite 1000, Atlanta, USA.
FAU - Lonnroth, Knut
AU  - Lonnroth K
AD  - WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of 
      Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
FAU - Wingfield, Tom
AU  - Wingfield T
AD  - WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of 
      Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
AD  - Clinical Sciences and International Public Health, Liverpool School of Tropical 
      Medicine, Liverpool, L3 5QA, Merseyside, UK.
AD  - Tropical and Infectious Disease Unit, Liverpool University Hospital NHS 
      Foundation Trust, Liverpool, L7 8XP, Merseyside, UK.
FAU - Annerstedt, Kristi Sidney
AU  - Annerstedt KS
AD  - WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of 
      Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
LA  - eng
GR  - WT_/Wellcome Trust/United Kingdom
GR  - MRF-131-0006-RG-KHOS-C0942/MRF/MRF/United Kingdom
GR  - MR/V004832/1/WT_/Wellcome Trust/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20231203
PL  - England
TA  - BMC Public Health
JT  - BMC public health
JID - 100968562
SB  - IM
MH  - Humans
MH  - *Health Care Costs
MH  - Prospective Studies
MH  - Vietnam/epidemiology
MH  - *Tuberculosis, Multidrug-Resistant/drug therapy/epidemiology
MH  - Income
PMC - PMC10693707
OTO - NOTNLM
OT  - Catastrophic costs
OT  - Longitudinal design
OT  - Multidrug-resistant tuberculosis
OT  - Patient Cost survey
OT  - Social protection
OT  - Viet Nam
COIS- CDC Foundation played no role in the design of the study and collection, and 
      analysis of data; however, one of the authors was employed by this funder and 
      assisted with interpretation of data and editing of the manuscript. No other 
      funding bodies played a role in the design of the study and collection, analysis, 
      and interpretation of data and in writing the manuscript.
EDAT- 2023/12/03 00:42
MHDA- 2023/12/04 12:43
PMCR- 2023/12/03
CRDT- 2023/12/02 23:15
PHST- 2023/01/23 00:00 [received]
PHST- 2023/10/26 00:00 [accepted]
PHST- 2023/12/04 12:43 [medline]
PHST- 2023/12/03 00:42 [pubmed]
PHST- 2023/12/02 23:15 [entrez]
PHST- 2023/12/03 00:00 [pmc-release]
AID - 10.1186/s12889-023-17078-5 [pii]
AID - 17078 [pii]
AID - 10.1186/s12889-023-17078-5 [doi]
PST - epublish
SO  - BMC Public Health. 2023 Dec 3;23(1):2372. doi: 10.1186/s12889-023-17078-5.