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A Care Pathway Analysis of Tuberculosis Patients in Benin: Highlights on Direct Costs and Critical Stages for an Evidence-Based Decision-Making

Author

Listed:
  • Samia Laokri
  • Arnaud Amoussouhui
  • Edgard M Ouendo
  • Athanase Cossi Hounnankan
  • Séverin Anagonou
  • Martin Gninafon
  • Ferdinand Kassa
  • Léon Tawo
  • Bruno Dujardin
Abstract
Background: Free tuberculosis control fail to protect patients from substantial medical and non-medical expenditure, thus a greater degree of disaggregation of patient cost is needed to fully capture their context and inform policymaking. Methods: A retrospective cross-sectional study was conducted on a convenience sample of six health districts of Southern Benin. From August 2008 to February 2009, we recruited all smear-positive pulmonary tuberculosis patients treated under the national strategy in the selected districts. Direct out-of-pocket costs associated with tuberculosis, time delays, and care-seeking pattern were collected from symptom onset to end of treatment. Results: Population description and outcome data were reported for 245 patients of whom 153 completed their care pathway. For them, the median overall direct cost was USD 183 per patient. Payments to traditional healers, self-medication drugs, travel, and food expenditures contributed largely to this cost burden. Patient, provider, and treatment delays were also reported. Pre-diagnosis and intensive treatment stages were the most critical stages, with median expenditure of USD 43 per patient and accounting for 38% and 29% of the overall direct cost, respectively. However, financial barriers differed depending on whether the patient lived in urban or rural areas. Conclusions: This study delivers new evidence about bottlenecks encountered during the TB care pathway. Financial barriers to accessing the free-of-charge tuberculosis control strategy in Benin remain substantial for low-income households. Irregular time delays and hidden costs, often generated by multiple visits to various care providers, impair appropriate patient pathways. Particular attention should be paid to pre-diagnosis and intensive treatment. Cost assessment and combined targeted interventions embodied by a patient-centered approach on the specific critical stages would likely deliver better program outcomes.

Suggested Citation

  • Samia Laokri & Arnaud Amoussouhui & Edgard M Ouendo & Athanase Cossi Hounnankan & Séverin Anagonou & Martin Gninafon & Ferdinand Kassa & Léon Tawo & Bruno Dujardin, 2014. "A Care Pathway Analysis of Tuberculosis Patients in Benin: Highlights on Direct Costs and Critical Stages for an Evidence-Based Decision-Making," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-8, May.
    • Handle: RePEc:plo:pone00:0096912
    DOI: 10.1371/journal.pone.0096912
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    References listed on IDEAS

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    1. Samia Laokri & Olivier Weil & Koiné Maxime Drabo & Sary Mathurin Dembelé & Benoît Kafando & Bruno Dujardin, 2013. "Removal of user fees no guarantee of universal health coverage: observations from Burkina Faso," ULB Institutional Repository 2013/153197, ULB -- Universite Libre de Bruxelles.
    2. Samia Laokri & Koiné Maxime Drabo & Olivier Weil & Benoît Kafando & Sary Mathurin Dembelé & Bruno Dujardin, 2013. "Patients are paying too much for tuberculosis: a direct cost-burden evaluation in Burkina Faso," ULB Institutional Repository 2013/153198, ULB -- Universite Libre de Bruxelles.
    3. Samia Laokri & Maxime Koiné Drabo & Olivier Weil & Benoît Kafando & Sary Mathurin Dembélé & Bruno Dujardin, 2013. "Patients Are Paying Too Much for Tuberculosis: A Direct Cost-Burden Evaluation in Burkina Faso," PLOS ONE, Public Library of Science, vol. 8(2), pages 1-6, February.
    4. Salla A Munro & Simon A Lewin & Helen J Smith & Mark E Engel & Atle Fretheim & Jimmy Volmink, 2007. "Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research," PLOS Medicine, Public Library of Science, vol. 4(7), pages 1-16, July.
    5. Salla A Munro, 2007. "Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research," Working Papers id:1107, eSocialSciences.
    6. Lönnroth, Knut & Jaramillo, Ernesto & Williams, Brian G. & Dye, Christopher & Raviglione, Mario, 2009. "Drivers of tuberculosis epidemics: The role of risk factors and social determinants," Social Science & Medicine, Elsevier, vol. 68(12), pages 2240-2246, June.
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    Cited by:

    1. Karun Sandeep Veesa & Kamalabhai Russell John & Patrick K Moonan & Saravanakumar Puthupalayam Kaliappan & Krishna Manjunath & Karuna D Sagili & Chinnappareddy Ravichandra & Pradeep Aravindan Menon & C, 2018. "Diagnostic pathways and direct medical costs incurred by new adult pulmonary tuberculosis patients prior to anti-tuberculosis treatment – Tamil Nadu, India," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-14, February.
    2. Samia Laokri & Rieza Soelaeman & David R Hotchkiss, 2018. "Assessing out-of-pocket expenditures for primary health care: how responsive is the Democratic Republic of Congo health system to providing financial risk protection?," ULB Institutional Repository 2013/273019, ULB -- Universite Libre de Bruxelles.

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