LIVERPOOL, England – Of all the hardships confronting tuberculosis patients in Vietnam, the most expensive is the time it takes. That includes the time lost to doctor visits in pursuit of a diagnosis, the time lost to getting and taking treatment. Then, for patients debilitated by illness and by the drugs hoped to deliver a cure, as well as for the family members who care for them, it includes the time lost that used to be spent working, particularly among families that had depended on every dollar coming in. Those costs alone account for about 68 percent of the costs of being a tuberculosis patient in Vietnam, and the reason that at least 59 percent of people being treated for the disease have incurred financial losses categorized as catastrophic by the World Health Organization.
Vietnam is not alone, apart from being one of the first countries to administer and report results of a national survey to measure the impoverishing impacts of a disease that, to begin with, disproportionately impacts some of the poorest members of societies. A session here this week presented data from that survey, as well as one administered in Myanmar, where an overall 64 percent of families affected by tuberculosis incurred catastrophic costs, with the greatest impacts among patients with the lowest incomes, and among patients sick with multidrug-resistant tuberculosis. The survey was developed by the World Health Organization to monitor progress toward its End TB strategy goal that no TB-affected household should experience catastrophic costs as a result of the disease.
The survey, however also is hoped to inform policies to improve tuberculosis responses, and in doing so improve patient outcomes and progress against the disease, Anna Vassall, a health economist at the London School of Hygiene & Tropical Medicine, who chaired the session where the data was presented. “We’ve known for a long time that TB patients have high costs,” she noted, “but we haven’t known how much, and where.”
As mentioned in earlier coverage here this week though, they can include the costs of X-rays, medicines, doctors fees, transportation, and often the ripple impacts of those, with patients taking loans at extortionate rates of interest, and selling income-producing assets (livestock was one example given), and purchasing medicines of questionable quality and origin — with the resulting risks of drug-resistance.
The result, Dame Margaret Whitehead of the World Health Organization said at a closing plenary Saturday, is a “vicious cycle” of poverty and disease. With contributing factors that include overcrowding, malnutrtion, and heightened exposures to environmental pollution, “poverty is a major driver of disease,” she noted, but then, with medical costs, opportunity costs, and recovery costs, she added, “disease is a major cause of impoverishment.”