Abstract:

Objective: To investigate the incidence and risk factors of catastrophic expenditure among patients with multidrug-resistant tuberculosis (MDR-TB) in Guangdong Province. Methods: The MDR-TB patients diagnosed in 11 designated medical institutions in 9 prefecture-level cities in Guangdong Province from 2018 to 2019 were selected. Questionnaires for surveying basic characteristics, patients’ disease and medical visit history, financial burden, and health insurance policies of medical institutions, individuals and cities were collected. A two-level logistic regression model was used to explore the risk factors of catastrophic expenditure in MDR-TB patients. Results: A total of 398 patients were included in this study. The median direct medical expenses was 51100 (22600, 98200) yuan; the median direct non-medical expenses was 14600 (7100, 33300) yuan; the median indirect costs was 5100 (3100, 7300) yuan; the median total costs was 84300 (42900, 147600) yuan; and the median total out-of-pocket expenses was 58400 (29700, 111800) per case. A total of 259 MDR-TB patients suffered with catastrophic expenditure, with an incidence of 65.08%. The two-level logistic regression model showed that the risk of catastrophic expenditure for households with debt was 2.57 times of that for households without debt (95%CI: 1.43-4.62). The incidence of catastrophic expenditure increased gradually with the patients’ hospitalization length, and the incidence for patients hospitalized for 1 month and ≥2 months were 4.38 (95%CI:2.38-8.06) times and 31.37 (95%CI: 11.09-88.74) times of that for non-hospitalized patients. Conclusion: A high incidence of catastrophic expenditure for MDR-TB patients was found in Guangdong Province. Debt and length of hospitalization were the risk factors for incidence of catastrophic expenditure. Multiple measures should be taken to reduce the incidence of catastrophic expenditure in MDR-TB patients.

Key words: Tuberculosis, multidrug-resistant, Drug costs, Factor analysis, statistical