Table 1 Characteristics of the included studies
Author, Year | Study design | Population criteria study duration | Study setting | Sample size and age | Results | Predictors |
|---|---|---|---|---|---|---|
Abayot, 2018(4) | Longitudinal study | New cases, older than 18 years, and on intensive phase treatment. | 10 districts of southwestern Ethiopia. | 735 new cases Age- median (IQR) of 27(20–37) years. | -Total pre-diagnosis cost- median (IQR) cost of US$97.6 (56.4–184.2) and direct cost constitutes 25.6%. -Total post-diagnosis cost-median (IQR) of US$93.75 (56.9–141.54) and direct cost constitutes 35.9%. - Total cost- median (IQR) of US$201.48 (136.70–318.94) and total direct cost constituted 29.4%. - For 471/569 (82.8%) of the cases, the total cost represents more than 10% of their estimated household annual income. | -For Pre- diagnosis cost- patient and provider delays, being clinically diagnosed, TB diagnosis at private facilities, and the number of visited healthcare facilities. -For post- Dx cost- being a rural resident, having a travel time beyond 1 h to the treatment center, being admitted for anti-TB treatment, patient, and provider delays. - Total cost- rural residence, travel time to treatment center beyond 1 h, action taken before HCF visit, hospitalized for anti-TB treatment, number of visited HCF, and patient and provider delays. |
Abraha, 2023 (26) | Cross-sectional study | TB patients | Oromia, Amhara, Southwest Ethiopia People, South Nation and Nationalities and Peoples Region, and Sidama. | 432 and 397 TB patients | -Catastrophic cost at 20% threshold in 2020 66% and in 2022 43.8%. - Baseline and follow-up mean direct and indirect costs were 2.17US$ and 1.62US$, respectively. - Direct medical costs, direct non-medical costs, and indirect costs at baseline were 11.6%, 76.2%, and 12.3%. -Direct medical costs, direct non-medical costs, and indirect costs during follow-up were 30.4%, 19.2%, and 52.4%. | |
Belete, 2010(27) | Cross-sectional study | Adult TB patients | Public health facilities in Addis Ababa. | − 604 TB patients. - Age- NA | -Total costs of TB illness to patients during DOT mean (SD) $177.3 (78.7) and the direct (OOP) cost mean (SD) $123.0 (58.8). -Direct mean treatment follow-up costs were $23.5. -OOP payments were catastrophic for 63% of TB patients. -Only 56 (9.7%) of TB patients had any kind of medical insurance scheme. -For the majority (90%) of TB patients, OOP payments were covered by their family members. | - The total cost- patient’s household income, residence, need for additional food, and primary income. |
Collins, 2018 (18) | Cross-sectional study | MDR-TB patients. | The University of Gonder Hospital, Saint Peter’s TB Specialized Hospital, and All Africa Leprosy, Tuberculosis and Rehabilitation Training Centre (ALERT) Hospital. | 169 MDR-TB patients. - Age- NA | - Total cost-US$1378. - Pre-diagnosis cost- US$83. - Intensive phase- US$661 and continuous phase US$634. - The impact on the patient’s employment and overall patient and family income was generally catastrophic: 74% of all respondents reported losing their jobs, 66% of patients lost household income, and household income was reduced by 38%. | NA |
Daniel, 2010 (16) | Community-randomized trial | Smear-positive patients. | Southern Nations, Nationalities, and Peoples’ Regional State | -229 smear-positive patients. -Age- mean (SD) 26.8 (13.7) for community DOT and 25.2 (11.8) years for health facility DOT. | - The cost of anti-TB drugs for a patient was US$22.1. - The transport and food costs were US$0.9 and US$2.8, respectively. -The cost per successfully treated patient was US$161.9 in health facility DOT and US$60.7 in community DOT. | NA |
Jason, 2020 (17) | Phase-III randomized controlled trial. | MDR-TB patients. | St. Peter’s Specialized Hospital and the Armauer Hansen Research Institute Hospital. | -119 MDR-TB patients. - Age- NA | - The cost was greater with the long than for the short regimen: the total cost per participant was US$ 6096.6 versus US$ 4552.3. - The mean cost of a serious adverse event in Ethiopia was higher for the long (US$ 82.1; 95% CI: 46.0 to 118.2) than the short regimen (US$ 15.7; 95% CI: 1.2 to 30.2). -The total direct costs per participant were US$ 575.4 for the long regimen and US$ 337.3 for the short regimen. | NA |
Lelisa, 2020 (25) | Cross-sectional survey. | Individuals seeking TB care. | 27 health facilities in Afar and Oromia regions. | − 787 individuals seeking TB care. -Age- mean (SD) 30 (14) years. | - The mean (SD) patient cost of HIV was $115 ($118) per TB episode. - Total direct cost of TB constituted 46%. - The total mean (SD) indirect cost was $63 ($83) per TB episode. -The productivity loss related to TB follow- up visits accounts for 36% of the total cost. - CHE incidence was 40% and ranged between 58% and 20% among the poorest and richest income quintiles. | - Private facility diagnosis, extra- pulmonary TB, hospitalized patients, being poorest, and TB/HIV co-infection was very likely to have TB- related CHE. - Every additional visit for TB diagnosis increases the odds of experiencing CHE by 2.4 times. - Households with a health insurance scheme have protection from CHE. |
Lelisa, 2020 (10) | Extended cost-effectiveness analysis modeling study. | TB, DS-TB, and MDR-TB patients. | NA | NA | - Active case finding could reduce TB-related deaths and catastrophic costs by 27% and 32%. - Enhancing DOTs for DS-TB would avert 25% of deaths and 15% of catastrophic costs. -Improvements in MDR- TB care would avert up to 1% and 6% of all deaths and catastrophic costs, respectively, over 2018- 35. | NA |
Mengiste, 2010 (24) | Cross-sectional survey. | New pulmonary tuberculosis patients ≥ 15 years old. | 10 districts of Tigray region. | − 924 newly diagnosed PTB patients (537 smear-positive and 387 smear-negative PTB). -Median age was 34 years. | - The total median cost incurred from the first consultation to diagnosis was $27 per patient (mean = $59). - The median costs per patient incurred by a patient, escort, and the public health system were $16 (mean = $29), $3 (mean = $23), and $3 (mean = $7) respectively. - The indirect and direct costs comprised 61% and 39% of the total cost spent to diagnose TB patients. | The total cost per patient diagnosed was higher for women, rural residents; those who received government food for work support, patients with smear-negative pulmonary tuberculosis, and patients who were not screened for TB in at least one district diagnostic center. |
Tsegahun, 2022 (15) | Open label RCT. | Adults aged 18 years or older with new or previously treated, bacteriologically confirmed, and drug-sensitive pulmonary TB. | 10 health care facilities in Ethiopia. | -109 participants. -Age- mean (SD) 33.1 (11.1) years. | -Median postdiagnosis cost was US $1.53. − 42 (38.5%) faced catastrophic costs due to TB treatment. | - Occupation, number of cohabitants, and smoking. |
Van, 2016 (23) | Cross-sectional survey. | TB and MDR-TB patients. | St. Peters and ALERT in Addis Ababa and University of Gondar Hospital in Gondar. | − 169 MDR-TB patients and 25 other TB patients. - Age- NA | -Total pre-diagnosis and treatment costs 260 USD. -Total pre-diagnosis costs of TB median (IQR) 14 (6–129). - Total pre-diagnosis costs for MDR-TB median (IQR) 68 (35–191). -Total pre-diagnosis and treatment costs for MDR-TB 1838 US$. - Percentage of patients reporting income loss due to TB was 92% and 79% due to MDR-TB. | NA |
Vassall, 2010 (21) | NA | Patients aged ⩾15 years who starting TB or HIV treatment. | Addis Ababa, Hosanna, and Jimma (urban, rural, and peri- urban). | -93 patients starting TB or HIV treatment. - Age- NA | - Pre-treatment costs were 35% of annual household income for TB patients (with no HIV) and 33% for those with TB and HIV. - Total mean pre-diagnosis cost for TB patients was US$ 129 and 170 for TB-HIV co-infection | NA |