Abstract:

Objective: To compare the changes in tuberculosis prevention and control indicators before and after the implementation of the “Zero Burden” strategy for tuberculosis diagnosis and treatment in Longyou County, Zhejiang Province, in order to provide scientific basis for formulating new tuberculosis prevention and control measures in a new stage. Methods: The reported incidence data of tuberculosis in all counties (cities, districts) of Quzhou City and counties bordering Longyou County (including Suichang County, Lanxi City, Wucheng District, and Jiande City) in Zhejiang Province from 2016 to 2022, as well as the admission rate and treatment outcome data of tuberculosis patients currently residing in Longyou County, were collected through the Tuberculosis Management Information System, a subsystem of China Disease Prevention and Control Information System. The number of permanent residents came from the local statistical yearbook. The data of diagnosis and treatment cost of pulmonary tuberculosis patients in Longyou County were from the information management system of Longyou County People’s Hospital. The interruption rate of treatment and policy satisfaction of pulmonary tuberculosis patients were mainly collected through surveys conducted by follow-up doctors in designated hospitals and community. Compare the diagnosis and treatment costs of tuberculosis patients, reported incidence rate of tuberculosis, admission rate of the county, treatment outcome and other indicators before (2016-2018) and after (2020-2022) the implementation of the “Zero Burden” strategy for tuberculosis diagnosis and treatment in Longyou County, and analyzed the implementation effect of the strategy. Results: Before the implementation of the “Zero Burden” strategy, the total personal payment expenses for tuberculosis patients were RMB 830322.45 yuan in 2016, RMB 833450.10 yuan in 2017, and RMB 792879.99 yuan in 2018. The personal payment expenses per tuberculosis patient were RMB 3075.27 yuan in 2016, RMB 3281.30 yuan in 2017 and RMB 3523.91 yuan in 2018. After the implementation of the “Zero Burden” strategy, the proportion of personal payment expenses for ordinary tuberculosis patients decreased to 0, and the county’s financial support expenses decreased year by year (RMB 492160.29 yuan, RMB 401349.56 yuan, and RMB 389319.42 yuan respectively from 2020 to 2022).The reported incidence rate of pulmonary tuberculosis in Longyou County was 74.17/10⁵ (270/364000) in 2016, and decreased to 47.21/10⁵ (169/358000) in 2022, the difference was statistically significant ($χ^{2}_{trend}=43.962$, P<0.001); the local admission rate of reported pulmonary tuberculosis patients had significantly increased from 74.81% (202/270) in 2016 to 93.49% (158/169) in 2022 ($χ^{2}_{trend}=64.483$, P<0.001); and the reported interruption rate of treatment for pulmonary tuberculosis patients significantly decreased from 6.30% (17/270) in 2016 to 1.18% (2/169) in 2022 ($χ^{2}_{trend}=17.965$, P=0.003). Conclusion: The implementation of the “Zero Burden” strategy for tuberculosis diagnosis and treatment in Longyou County, Zhejiang Province reduced the medical burden of tuberculosis patients, increased the local admission rate, reduced the rate of patients’ treatment interruption and the overall reported incidence rate of tuberculosis, and the implementation effect of the strategy has appeared tentatively.

Key words: Tuberculosis, pulmonary, Fees, medical, Health policy, Evaluation studies