title: Direct costs of pulmonary tuberculosis among patients receiving treatment in Bauchi State, Nigeria.
abstract: BACKGROUND
  To access tuberculosis (TB) services, patients have to bear the costs of out-of-pocket expenditures or direct costs for transport, drugs and other services that are not provided free-of-charge. These costs could represent a barrier to care, especially in a country such as  Nigeria, where per capita gross national income is only US$1160 and 46% of the urban population live below the poverty line.
  
  
  OBJECTIVE
  To describe the direct costs of TB diagnosis and treatment in Bauchi State, Nigeria, from the patient's perspective.
  
  
  METHODS
  A cross-sectional  study. A sample size of 255 patients was randomly selected from 27 of 67 facilities in Bauchi State, Nigeria.
  
  
  RESULTS
  The median out-of-pocket cost for hospitalised patients was estimated at US$166.11, while ambulatory patients paid an estimated median cost of US$94.16, equivalent  to about 9-38% of their average annual income. Female patients spent a higher proportion of their income on diagnosis and treatment than males (P < 0.0001). The median out-of-pocket costs borne by patients before, during and after diagnosis were estimated at respectively US$35.23,  US$27.12 and US$23.43 for ambulatory patients, and additional average out-of-pocket spending of US$66.44 for patients hospitalised during their illness. Pre-diagnosis, diagnosis and post-diagnosis out-of-pocket spending did not vary significantly by human immunodeficiency  virus status (P > 0.05) and sex (P > 0.05).
  
  
  CONCLUSIONS
  The costs of anti-tuberculosis treatment found in this study are expensive and potentially catastrophic for many patients and their families.
authors.affiliation: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK. nisser.au@usa.net
authors.forename: N A
authors.initials: NA
authors.lastname: Umar
authors.forename: I
authors.initials: I
authors.lastname: Abubakar
authors.forename: R
authors.initials: R
authors.lastname: Fordham
authors.forename: M
authors.initials: M
authors.lastname: Bachmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D000995:Antitubercular Agents / Q000191:economics* / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D003430:Cross-Sectional Studies; D016527:Drug Costs; D005260:Female; D005382:Financing, Personal; D017048:Health Care Costs; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009549:Nigeria / Q000453:epidemiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents