Out-of-pocket payment and catastrophic health expenditure of Tuberculosis (TB)patients in accessing care at (public-private mix) PPM clinics in Myanmar (2022)

Abstract

Background The financial burden of tuberculosis (TB) can hinder patients and their families, creating obstacles throughout the care cascade, despite TB prevention and control being provided free of charge. The study focused on quantifying the financial burden faced by TB patients seeking care in Myanmar's private health sector. Methods This cross-sectional telephone survey included 695 adults seeking TB treatment from various private providers in four states and regions with high TB burden in Myanmar. Telephone interviews were conducted in May and June 2022. Both direct and indirect costs incurred from the patient and their household perspective were valued in 2022 and estimated throughout pre- and post-TB diagnosis episodes. The TB-affected households were defined as experiencing catastrophic health expenditure if their expenditure due to TB exceeded 40% of their capacity to pay, as recommended by the World Health Organization. Logistic regression analysis was done to identify the determinants of catastrophic health expenditure. Results The findings showed patients made a median of 7.9 clinic visits throughout their treatment, with the median total cost for the entire TB treatment being $53.4, including direct medical and testing costs ($11.8) and direct non-medical patient expenditure ($11.6). Pre-treatment costs were higher compared to post-treatment costs. During the intensive phase, TB care cost was nearly free, but during the continuation phase, it was a median of $2.6. About 16.1% of patients experienced catastrophic health expenditure due to TB treatment, with expenses exceeding 40% of their capacity to pay. Multivariate regression analysis revealed that patients with a history of hospitalization (AOR,11.46; P<0.01), seeking care from regions other than Yangon (AOR, 2.8; P<0.01), and using coping strategies (AOR, 10.35; P<0.01), were more likely to face catastrophic financial burdens. Higher monthly household income (over 300,000 MMKs or 162 USD) was associated with a decreased risk of incurring catastrophic health expenditure (AOR, 0.29; P<0.01). Conclusions Persons with TB in Myanmar faced risk of catastrophic costs, even when treated in the private sector with free diagnostic charges and anti-TB medicine. The study highlighted the need for additional strategies or policies to make TB care affordable and mitigate the financial burden of TB-affected households.