Table 1

Summary of Studies
Author (Year) Country Type of study Population under study Primary objectives Types of costs reported Time period of costs (Pre vs. post diagnosis)
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

Barter et al.

Barter et al. BMC Public Health 2012 12:980   doi:10.1186/1471-2458-12-980

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