Costs and performance analysis of tuberculosis patients in seeking care : a case study at Yosse TB Center

Abstract

The performance of tuberculosis (TB) patients prior to the formal care is an important factor to reduce the pool of infection and transmission. As the disease is more prevalent among the low income group, cost when seeking informal care generally is a cause of economic burden to the patients. It the patients delay in seeking formal care, the costs to the patients are expected to be higher. Therefore, it is important to quantify the economic implication of such delay. In view of this, a study was carried out to quantify patients' delay in seeking care and the economic costs to the patients prior to formal care and also to identify the relationship between socio-economic characteristics and performance in Bangkok. Bangkok Chest Clinic was selected as the study site. Patients reporting at the clinic during the period 15th February to 22nd March 1995 were interviewed using structured questionnaire. Information on costs and performance was collected from 96 patients representing the age class above 15 years. The time delay in seeking formal care from the onset of perceived symptoms was 33.9 days. Prior to formal care patients were reported to seek care at several other service points including drug stores, Private clinics, Health Centers and BMA Clinics. Majority opted drug stores as their initial choice for diagnosis and treatment. The cost components identified and quantified were travel fare and travel time costs of the patients and their accompanying persons, consultation and drug costs and time costs due to work days lost. The mean cost incurred by the patient was 1729 bahts prior to formal care. There was a significant (p=0.024) association between performance and total cost to the patients. Economic costs due to opportunity (time) cost on travel and work lost was the major cost constituting 70% of the total cost. When this cost is extrapolated to the entire population of the country, patients incurred Baht 4915,283. From the results of this study it may be recommended that steps may be initiated to decentralize case finding and treatment services. Health education campaigns need to be intensified to promote health awareness. These two processes may be useful in reducing the delay in seeking care at appropriate service (formal) points and reduce the cost to the society as well.