Direct Medical Expenses and Influencing Factors of MDR/RR-TB in Eastern China: Based on Data from Multi-Hospital Information Systems

Meng Zhou,1 Ying Peng,2 Kui Liu,2 Lin Zhou,2 Fei Wang,2 Xinyi Chen,2 Bin Chen,2,3,* Chonggao Hu2,* 1Department of Social Medicine of School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China; 3School of Public Health, Fudan University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Bin Chen; Chonggao Hu, Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China, Email bchen@cdc.zj.cn; chghu@cdc.zj.cnBackground: Multidrug-resistant (MDR) and rifampicin-resistant (RR) tuberculosis (TB) is related to high healthcare costs. However, studies on direct healthcare expenditure in different settings remain inconclusive. Hence, we aimed to examine the direct medical expenses (DME) of patients with MDR/RR-TB and assessed which patient characteristics were associated with higher costs.Methods: DME was evaluated using records from the hospital information system in three cities with different economic levels in Zhejiang Province, Eastern China, matching with data (including socio-demographics, disease treatment status, etc.) collected in the Tuberculosis Management Information System. A logistic regression model was used to identify variables associated with higher costs.Results: Of 193 patients with MDR/RR-TB, the average DME was $10,491 (interquartile range (IQR) $4679– 16,710), consisting of $2696 (IQR $1019– 5100) out-of-pocket costs, medical reimbursement, and subsidies, accounting for 32%, 50.3% and 14%, respectively. A total of 74.2% and 56% of DME were for drugs and anti-TB drugs, respectively. Only 16.9% of the patients were treated with an all-oral regimen. Higher DME was significantly associated with local residents 7.29 (95% confidence interval (CI) [2.62– 20.3]), hospitalization experience 7.63 (95% (CI) [2.54– 22.95]), longer duration of treatment 6.63 (95% CI [2.27– 19.35]), and lower health insurance reimbursement 5.65 (95% CI [1.90– 16.79]).Conclusion: DME of patients with MDR/RR-TB was still significant, and domestic migrants, hospitalization, long treatment duration, and high health insurance rates increased the financial burden on MDR/RR-TB patients. Reasonable intervention programs should be developed to reduce the medical burden of patients with MDR/RR-TB, according to the DME and its component of MDR-TB patients, besides the economic status of their regions.Keywords: multidrug-resistant tuberculosis, rifampicin-resistant tuberculosis, direct medical expenses, anti-TB drugs, burden