Author(s)

Júlia Malache António^1*, Domingas Pacala^2*, Isabelle Munyangaju^3,4#, Isaías Benzana⁵, Claudia Mutaquiha², Dulce Osório⁴, Benedita José², Edy Nacarapa⁴, Pereira Zindoga²

¹Faculdade de Ciências de Saúde, Universidade Católica de Moçambique, Beira, Moçambique.
²Programa Nacional de Controlo da Tuberculose, Ministério da Saúde de Moçambique, Maputo, Moçambique.
³ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
⁴Tinpswalo Association, Vincentian Association to Fight AIDS and TB, Chokwe, Mozambique.
⁵Centro de Estudos e Apoio Psicológico (CEAP), Universidade Eduardo Mondlane, Maputo, Moçambique.

Introduction: Tuberculosis is closely linked to poverty, with patients facing significant indirect treatment costs. Treating drug-resistant tuberculosis further increases these expenses. Notably, there is a lack of published data on the indirect costs incurred by patients with drug-resistant tuberculosis in Mozambique. Objective: To assess the indirect costs, income reduction, and work productivity incurred by patients undergoing diagnosis and treatment for Drug-Resistant Tuberculosis (DRTB) in Mozambique during their TB treatment. Methods: As part of a comprehensive mixed-methods study conducted from January 2021 to April 2023, this research utilized a descriptive cross-sectional approach, incorporating both quantitative and qualitative methods. The primary goal was to evaluate the costs incurred by the national health system due to drug-resistant TB. Additionally, to explore the indirect costs experienced by patients and their families during treatment, semi-structured interviews were conducted with 27 individuals who had been undergoing treatment for over six months. Results: All survey participants unanimously reported a significant decline in labour productivity, with 70.3% experiencing a reduction in their monthly income. Before falling ill, the majority of respondents (33.3%) earned up to $76.92 monthly, representing the minimum earnings range, while 29.2% had a monthly income above $230.77, the maximum earnings range. Among those who experienced income loss, the majority (22.2%) reported a decrease of up to $76.92 per month, and 18.5% cited a loss exceeding $230.77 per month. Notably, patients with Drug-Resistant Tuberculosis (DRTB) have not incurred the direct costs of the disease, as these are covered by the government. Conclusion: The financial burden of treating Drug-Resistant Tuberculosis (DRTB), along with the income reduction it causes, is substantial. Implementing a patient-centred, multidisciplinary, and multisector approach, coupled with strong psychosocial support, can significantly reduce the catastrophic costs DRTB patients incur.

Economic Costs, Drug Resistance, Tuberculosis, Catastrophic Costs

António, J.M., Pacala, D., Munyangaju, I., Benzana, I., Mutaquiha, C., Osório, D., José, B., Nacarapa, E. and Zindoga, P. (2024) Assessment of the Indirect Cost of Drug Resistant Tuberculosis Treatment to Patients in a High Burden, Low Income Setting in Mozambique. Journal of Tuberculosis Research, 12, 91-104. doi: 10.4236/jtr.2024.122006.