title: Cost of tuberculosis diagnosis and treatment from the patient perspective in Lusaka, Zambia.
abstract: METHODS
  Urban primary health centres in Lusaka, Zambia.
  
  
  OBJECTIVE
  1) To estimate patient costs for tuberculosis (TB) diagnosis and treatment and 2) to identify determinants of patient costs.
  
  
  METHODS
  A cross-sectional survey of 103 adult TB patients who had been on treatment for 1-3 months was conducted using a standardised questionnaire. Direct and indirect costs were estimated, converted into US$ and categorised into two time periods: 'pre-diagnosis/care-seeking' and 'post-diagnosis/treatment'. Determinants of patient costs were analysed using multiple linear regression.
  
  
  RESULTS
  The median total patient costs for diagnosis and 2 months of treatment was $24.78 (interquartile range 13.56-40.30) per patient--equivalent to 47.8% of patients' median monthly income. Sex, patient delays in seeking care and method of treatment supervision were significant predictors of total patient costs. The total direct costs as a proportion of income were higher for women than men (P < 0.001). Treatment costs incurred by patients on the clinic-based directly observed treatment strategy were more than three times greater than those incurred by patients on the self-administered treatment strategy (P < 0.001).
  
  
  CONCLUSIONS
  Clinic-based treatment supervision posed a significant economic burden on patients. The creation or strengthening of community-based treatment supervision programmes would have the greatest potential impact on reducing patients' TB-related costs.
authors.affiliation: Respiratory Epidemiology Unit, Montreal Chest Institute, Montreal, Quebec, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Aspler
authors.forename: D
authors.initials: D
authors.lastname: Menzies
authors.forename: O
authors.initials: O
authors.lastname: Oxlade
authors.forename: J
authors.initials: J
authors.lastname: Banda
authors.forename: L
authors.initials: L
authors.lastname: Mwenge
authors.forename: P
authors.initials: P
authors.lastname: Godfrey-Faussett
authors.forename: H
authors.initials: H
authors.lastname: Ayles
mesh_terms: D000328:Adult; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D014376:Tuberculosis / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D015024:Zambia