title: Patients' costs associated with seeking and accessing treatment for drug-resistant tuberculosis in South Africa.
abstract: METHODS
  South Africa is one of the world's 22 high tuberculosis (TB) burden countries, with the second highest number of notified rifampicin-resistant TB (R(R)-TB) and multidrug-resistant TB (MDR-TB) cases.
  
  
  OBJECTIVE
  To estimate patient costs associated with the diagnosis and treatment of R(R)-TB/MDR-TB in South Africa.
  
  
  METHODS
  Patients diagnosed with R(R)-TB/MDR-TB and accessing care at government health care facilities were surveyed using a structured questionnaire. Direct and indirect costs associated with accessing R(R)-TB/MDR-TB care were estimated at different treatment durations for each patient.
  
  
  RESULTS
  A total of 134 patients were surveyed: 84 in the intensive phase and 50 in the continuation phase of treatment, 82 in-patients and 52 out-patients. The mean monthly patient costs associated with the diagnosis and treatment of R(R)-TB/MDR-TB were higher during the intensive phase than the continuation phase (US$235 vs. US$188) and among in-patients than among out-patients (US$269 vs. US$122). Patients in the continuation phase and those accessing care as out-patients reported higher out-of-pocket costs than other patients. Most patients did not access social protection for costs associated with R(R)-TB/MDR-TB illness.
  
  
  CONCLUSIONS
  Despite free health care, patients bear high costs when accessing diagnosis and treatment services for R(R)-TB/MDR-TB; appropriate social protection mechanisms should be provided to assist them in coping with these costs.
authors.affiliation: Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Ramma
authors.affiliation: Division of Medical Microbiology, and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: H
authors.initials: H
authors.lastname: Cox
authors.affiliation: Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Wilkinson
authors.affiliation: Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Foster
authors.affiliation: Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Cunnama
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Vassall
authors.affiliation: Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: E
authors.initials: E
authors.lastname: Sinanovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010342:Patient Acceptance of Health Care; D011203:Poverty; D013019:South Africa; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000191:economics*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents