Case studies from Benin and Burkina Faso: direct and indirect economic burden of Tuberculosis: Conference proceedings

Background: A pilot research protocol has been adapted from Burkina Faso to Benin – whose results were published in February 2013 in PLoS ONE. The study located in Benin involved six health districts from urban and rural areas covering a population of 1,348,700 inhabitants. The aim was to measure economic burden of tuberculosis care pathway.Methods: A retrospective cross-sectional study reviewed all smear-positive tuberculosis patients treated under the national strategy from August 2008 to February 2009 in the selected districts. Out-of-pocket payments associated with tuberculosis and care-seeking pattern and opportunity costs were exhaustively collected from onset of symptoms to end of treatment. Household income was also investigated to report on financial burden.Findings: Population pattern and outcomes data were reported for the 245 tuberculosis patients interviewed. The mean age was 35 years; 60% (146) were male and median overall direct cost was US$ 163 per patient. Patient, provider, and treatment delays were reported. Pre-diagnosis stage was the most critical; corresponding to a median of 38% of the overall direct cost. Self-medication, travel and food expenditures contributed largely to this cost-burden. Patients also reported opportunity costs and the median of direct economic burden achieved 2 months of their household income and represented 17% of the annual household income.Interpretation:The study showed particular financial and organisational barriers that need to be tackled during critical stages. The most critical stage was pre-diagnosis followed by intensive treatment stage; whereas in Burkina Faso those were likely diagnosis process, treatment initiation and pre-diagnosis in decreasing order of importance. Out-of-pocket payments for TB in Benin remain prohibitive and are much higher than payments observed in rural Burkina Faso. However, direct economic burden appeared slightly higher than in rural Burkina Faso.