Table 1 Summary of Studies

Aspler, et al. (1998) [41]

Zambia

Cross-sectional

103 patients aged ⩾18 years with active or extra-pulmonary TB who had been on treatment for 6-10 weeks

To estimate TB patient costs for treatment and diagnosis and cost determinants

Pre-diagnosis, treatment, time, travel, medication, consultation, hospitalization, food, health insurance, and diagnostic test costs

Both

Awofeso, N. (1998) [42]

Nigeria

Prospective cohort

2144 symptomatic smear-positive patients in two study periods

To discuss the implications of pre-payment versus free medication therapy on treatment and case-finding of TB patients

Medication costs

Post-diagnosis

Bevan, E. (1997) [43]

Kenya

Unknown

Unknown

Letter to describe other costs associated with DOTS

Daily inpatient care, travel, and other medical expenses

Post-diagnosis

Brouwer, et al. (1998) [44]

Malawi

Cross-sectional

89 smear-positive pulmonary TB patients admitted to Queen Elizabeth Central Hospital

To investigate how TB patients utilize traditional healers and traditional medicine in their care-seeking behaviors

Total fixed and variable costs, time, and traditional healer costs

Pre-diagnosis

Cambanis, et al. (2005) [45]

Ethiopia

Cross-sectional

243 patients undergoing sputum examination for TB diagnosis

To assess factors related to patient delay in presenting to health services for the diagnosis of TB

Time and travel costs

Pre-diagnosis

Chard, S. (2001) [46]

Uganda

Cross-sectional

89 female patients aged ⩾18 years identified from a TB clinic

To examine treatment seeking, health beliefs, and social networks of female Ugandan TB patients

Time, travel, medication, traditional healers, and costs for “tipping” healthcare providers

Both

Chard, S. (2009) [47]

Uganda

Cross-sectional

65 women aged ⩾18 years with a diagnosis of pulmonary TB, and receiving outpatient TB treatment from one of three TB clinics

To explore the TB treatment-seeking process of Ugandan women in order to determine the routes to effective government TB treatment

Private providers and traditional healer costs

Both

Datiko and Lindtjørn (2010) [48]

Ethiopia

Cost-effectiveness analysis

229 smear-positive patients

To determine the cost and cost-effectiveness of involving health extension workers in TB treatment under a community-based model

Time, caregiver, food, direct, and total costs

Post-diagnosis

Edginton, et al. (2002) [49]

South Africa

Qualitative

114 hospital TB patients and 75 clinic TB patients and community members were interviewed

To assess the beliefs and experiences about TB from the perspective of patients and community members in order to assess the impact of presentation to health services and treatment adherence

Time and travel costs

Post-diagnosis

Floyd, et al. (2003) [50]

Malawi

Cost-effectiveness analysis

2,174 new smear-positive and -negative patients registered for treatment in 1997; 2,821 new smear-positive and -negative patients registered for treatment in 1998

To assess the cost and cost-effectiveness of new treatment strategies for new pulmonary TB patients introduced in Malawi in 1997

Time, travel, hospitalization, caregiver, and DOTS costs

Post-diagnosis

Floyd, et al. (1997) [51]

South Africa

Cost-effectiveness analysis

New smear-positive adult patients

To conduct an economic evaluation of directly observed treatment and conventionally delivered treatment for the management of new adult TB cases

Time, travel, hospitalization, total, and DOTS costs

Post-diagnosis

Gibson, et al. (1998) [52]

Sierra Leone

Cross-sectional

54 inpatients, 18 outpatients, and 17 staff members in 6 TB Centers

To evaluate the impact of patient poverty and staff salaries on patient costs for TB treatment within a sub-national TB program

Pre-program, program time, and total costs

Both

Harper, et al. (2003) [53]

The Gambia

Qualitative

443 patients and clinic staff participated in focus groups, in-depth interviews, and semi-structured interviews

To evaluate the factors related to shortages of case tracing and adherence to treatment using qualitative methods with a cohort of TB patients

Travel and private treatment costs

Both

Kemp, et al. (2007) [54]

Malawi

Cross-sectional

179 smear-positive and -negative TB patients who were in the intensive phase of treatment

To assess the relative costs of accessing a TB diagnosis for the poor and for women in urban Lilongwe, Malawi, where public health services are accessible within 6km and are provided free of charge

Time, travel, medication, and food costs

Both

Mesfin, et al. (2010) [55]

Ethiopia

Prospective cohort

537 newly diagnosed smear-positive pulmonary TB patients and 387 newly diagnosed smear-negative pulmonary TB patients ≥15

To investigate costs of TB diagnosis incurred by patients, their escorts, and the public health system in 10 districts in Ethiopia

Caregiver, time, travel, medication, consultation, hospital admission, and lodging costs

Both

Moalosi, et al. (2003) [56]

Botswana

Cost-effectiveness analysis

50 caregivers of TB patients on home-based care

To determine the affordability and cost-effectiveness of home-based DOTS vs. hospital-based DOTS for TB patients and to describe the characteristics of patients and their caregivers

Total, time, travel, medication and hospitalization costs for caregivers

Both

Needham, et al. (1996) [57]

Zambia

Cross-sectional

23 adult inpatients and outpatients with a diagnosis of pulmonary TB

Letter in response to Pocock et al. 1996 to assess patient-related economic barriers to TB diagnosis in Lusaka, Zambia

Medical, non-medical, time, and caregiver costs

Both

Needham, et al. (1998) [58]

Zambia

Cross-sectional

202 adult inpatients and outpatients registering with new pulmonary TB at the Chest Clinic

To study the pre-diagnosis economic impact burden and barrers to care seeking for TB patients in urban Zambia

Time, travel, consultation, caregiver, private provider, traditional healer, insurance, diagnostic, treatment, and food costs

Both

Needham, et al. (2004) [59]

Zambia

Qualitative

202 adult patients with pulmonary tuberculosis

To assess the barriers to successful care seeking faced by TB patients in urban Zambia

Time, travel, caregiver, and government health insurance costs

Pre-diagnosis

Nganda, et al. (2003) [60]

Kenya

Cost-effectiveness analysis

New smear-positive, new smear-negative and extra-pulmonary adult patients; for each type of patient, two alternative approaches to treatment were evaluated: the conventional approach used until September 1997 and the new approach introduced in October 1997

To assess the cost and cost-effectiveness of new treatment strategies, involving decentralization of care from hospitals to peripheral health facilities and the community, compared to the conventional approaches used until October 1997

Total, travel, hospitalization, TB clinic, and DOTS costs

Post-diagnosis

Okello, et al. (2003) [61]

Uganda

Cost-effectiveness analysis

New smear-positive pulmonary patients under two strategies: the conventional hospital-based approach used from 1995 thorough 1997, and the new community-based approach introduced in 1998

To assess the cost and cost-effectiveness of conventional hospital-based care with the new community-based care for new smear-positive pulmonary TB patients

Time, travel, hospitalization, and total DOTS costs

Post-diagnosis

Pocock, et al. (1996) [62]

Malawi

Cross-sectional

100 adult patients with smear-positive and extrapulmonary TB admitted to the TB ward, Queen Elizabeth Central Hospital, for 2 months of treatment

Letter investigating impacts of long hospitalization from the patients’ perspective

Time costs

Post-diagnosis

Saunderson, P.R. (1995) [31]

Uganda

Cost-effectiveness analysis

34 patients attending a hospital run by a non-governmental organization

To analyze the costs and cost-effectiveness of the current TB control strategy and an alternative ambulatory treatment strategy

Total, time, hospitalization, and pre-diagnosis costs

Both

Sinanovic, et al. (2003) [63]

South Africa

Cost-effectiveness analysis

New smear-positive and retreatment pulmonary TB patients started on treatment in two townships of Metropolitan Cape Town (Guguletu, where both clinic and community care were provided, and Nyanga, whereonly clinic-based care was provided)

To evaluate the affordability and cost-effectiveness of community involvement in TB care

Total, time, and travel costs

Post-diagnosis

Sinanovic and Kumaranay-ake (2006) [64]

South Africa

Cost-effectiveness analysis

1,182 new sputum positive patients at 2 public-private workplace sites (PWP), 2 public-non-governmental organization partnership sites (PNP) and 2 purely public sites

To estimate the cost and cost-effectiveness of different types of public-private-partnerships in TB treatment and the financing required for the different models from the provincial TB program from the patient and provider perspective

Total, time, and travel costs

Post-diagnosis

Steen and Mazonde (1999) [30]

Botswana

Cross-sectional

212 New and retreated patients with smear-positive pulmonary TB

To estimate the health-seeking behaviors of TB patients and their beliefs and attitudes of the disease

Outpatient fees

Post-diagnosis

Vassall, et al. (2010) [65]

Ethiopia

Cross-sectional

250 patients ⩾ 15 years using TB-HIV pilot services and diagnosed with and being treated for TB, HIV, or both

To measure patients costs of TB-HIV services from hospital-based pilot sites for collaborative TB-HIV interventions

Direct, indirect, transport, total

Both

Wandwalo, et al. (2005) [66]

Tanzania

Cost-effectiveness analysis

42 treatment supervisors and 103 new smear-positive, smear-negative, and extrapulmonary TB patients 5 years

To determine the cost and cost-effectiveness of community-based DOTS versus health facility treatment of TB in urban Tanzania

Direct, indirect, time, and total costs

Post-diagnosis

Wilkinson, et al. (1997) [67]

South Africa

Cost-effectiveness analysis

TB patients under the Hlabisa strategy (1991-preent), the former Hlabisa strategy (until 1991), the Department of Health strategy, and the SANTA strategy based on sanatorium care

To conduct an economic analysis of the Hlabisa community-based DOTS management compared to three alternative strategies

Total, hospitalization, and travel costs

Post-diagnosis

Wyss, et al. (2001) [68]

Tanzania

Cross-sectional

191 TB cases in 3 surveillance areas who had smear-positive, extrapulmonary, or relapse TB

To assess household level costs of TB and to compare them with provider costs of the National TB Control Program

Diagnostic test, time, traditional healer, private provider, hospitalization, caregiver, and travel costs

Both