Cost of Tuberculosis Care in Programmatic Settings from Karnataka, India: Is It Catastrophic for the Patients?
Table 1
Operational definitions used in the study.
(1) Total prediagnostic and diagnostic costs: it includes any costs incurred directly or indirectly before the diagnosis and during the diagnosis of TB (namely, any laboratory investigations and costs towards diagnosis of other morbidity)
(2) Total postdiagnostic and treatment costs: it includes any costs incurred directly or indirectly for the purpose of treatment or follow-up or loss of wages by the patients
(3) Direct medical costs: it includes any cost incurred on consulting a doctor and the expenditure made on investigations and drugs including expenses on non-TB drugs
(4) Direct nonmedical cost: it includes costs incurred towards travel, accommodation, and special food for the patient and the accompanying personnel
(5) Indirect costs: it includes costs due to loss of wages of the patient due to illness and debilitating condition leading to decreased capacity to work thus necessitating change in the type of work performed
(6) Total cost: it comprises expenditure during the pretreatment and the treatment phase under direct and indirect cost categories
(7) Coping cost: these are the costs that are incurred through coping strategies of a household to meet daily requirements despite the extra expenditures or loss of income. It includes the sale of fixed or moveable assets, loans, saving on food or other items, the patient attendant leaving a job/taking leave to care for the patient, taking a child out of school to care for the patient, or taking up another job [9, 13, 14]
(8) Out-of-pocket expenditure (OPE): it includes direct health expenditures on diagnosis and treatment (consultation fees, laboratory investigations, radiography, drugs, and hospital charges for services) and associated nonmedical expenses (transport and accommodation costs for patient and attendants and nutrition supplement costs) but not income loss [15]
(9) Catastrophic cost: if more than 10% of the average monthly income is spent/claimed to be spent as TB-related expenditures, then it is considered catastrophic [16]
