47th Union World Conference on Lung Health: Even “free” TB treatment can come with catastrophic costs

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Science Speaks is in Liverpool this week covering developments and impacts in global tuberculosis research, programming and funding.

Science Speaks is in Liverpool this week covering developments and impacts in global tuberculosis research, programming and funding.

LIVERPOOL, England – Even before the costs of getting diagnosed, picked up in some high-tuberculosis incidence countries by patients themselves, and even before treatment brings its own costs, the financial toll of tuberculosis has already begun, a representative of the World Health Organization said today. Those costs include medical expenses incurred on the way to the screening and testing that finally leads to answers, related, but non-medical expenses that include transportation, and lost work hours during all of that.

Those alone can make up about half the costs of being sick with tuberculosis, with more to follow as treatment, hospitalization (where patients may have to supply their own food and linens) side-effects, stigma and debilitation bring more costs. And those in turn bring higher risks of treatment failure, recurring disease, and new infections for other household members. When those costs exceed 20 percent of a family’s annual income, their impact on the household can be catastrophic, with the most destructive impacts, naturally, falling upon households with the lowest incomes to begin with, said Ines Garcia Baena of WHO Tuesday.

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Former tuberculosis patient Ingrid Oxley of South Africa, David Bryden of RESULTS, and Ines Garcia Baena discuss the financial impacts of tuberculosis in a panel discussion led by Bryden Wednesday.

She was speaking in a panel discussion asking “Is TB Care Really Free?” and the short answer is that it definitely is not.

But while the World Health Organization’s End TB Strategy includes a target that no household should experience catastrophic costs due to tuberculosis, national TB programs are just beginning  to tally the costs that can add up to ruin for a family affected by the disease. A total of 34 countries have signed on to administer a survey to tuberculosis patients in care settings since the WHO launched the project in 2015 to identify and quantify the greatest financial and economic hits that come with tuberculosis (with “financial” reflecting direct costs, and “economic” reflecting impacts that include unemployment, loans, and loss of assets) and to find ways to avert them.

Preliminary results from surveys in Myanmar and Viet Nam will be released later this week.

But in the meantime, patients and advocates in the session pointed to known avertable costs, that included paying for quack cures, and unemployment extended well beyond the period of infectiousness and symptoms, due in both cases to bad information surrounding the disease. And although those costs are known, impacting patients in Peru where treatment is free, they must demonstrate them to back calls for responsive policy and funding, Carlton Evans of the London School of Hygiene and Tropical Medicine said.

Stay tuned. We look forward to learning the results of early surveys Thursday.

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