Abstract:

Objective: To investigate the current situation and influencing factors of the direct self-paid medical expenses of multidrug-resistant tuberculosis (MDR-TB) patients in Guangzhou City, providing a basis for optimizing medical reimbursement policies for MDR-TB patients. Methods: A self-designed questionnaire was used to conduct face-to-face or telephone interviews on factors related to MDR-TB in 284 patients who completed treatment receive treatment in the MDR-TB clinic of Guangzhou Chest Hospital from January 1, 2020 to December 31, 2022.The direct self-paid medical expenses and information of examinations of patients (including laboratory examination fees, anti-tuberculosis drug fees, non tuberculosis drug fees, hospitalization fees, etc.) were collected through the hospital information system. Descriptive statistical analysis, Chi square test, and other methods were used to analyze direct self-paid medical expenses of MDR-TB patients with different age, gender, family income, occupation, and education levels. Stepwise multiple linear regression was conducted to analyze the influencing factors of direct self-paid medical expenses (α=0.05). Results: The median (quartile) direct self-paid medical expenses of 284 MDR-TB patients was 99927.25 (40136.45, 202526.91) RMB yuan, the top three were anti-TB drug expenses, laboratory examination expenses, and non-anti-TB drug expenses, with median (quartile) of 46676.27 (5590.92, 150869.86) RMB yuan, 22130.59 (15609.23, 31417.06) RMB yuan, and 12751.68 (7977.07, 19418.64) RMB yuan, respectively.In the multi-factorial analysis model, the protective factors for self-paid medical expenses of MDR-TB patients were Guangzhou City household registration (OR (95%CI)=0.95 (0.84-0.99)), and full face-to-face medication management (OR (95%CI)=0.73 (0.65-0.87)), and the risk factors for self-paid medical expenses of MDR-TB patients were having adverse drug reactions (OR (95%CI)=1.33 (1.19-1.46)), using linezolid (OR (95%CI)=2.23 (1.92-2.59)), and having hospitalization (OR (95%CI)=1.57 (1.32-1.91)). Conclusion: The self-paid medical expenses of multidrug-resistant tuberculosis patients in Guangzhou are high, and the management of multidrug-resistant patients’ medication should be standardized to reduce adverse drug reactions and optimize medical reimbursement policies.

Key words: Mycobacterium tuberculosis, Tuberculosis, resistant to multiple drugs, Expenses, medical, Factor analysis, statistics