Comparison of two cash transfer strategies to prevent catastrophic costs for poor tuberculosis-affected households in low- and middle-income countries: An economic modelling study

• DOI: 10.1371/journal.pmed.1002418
• Publication Date: 2017-11-07T18:24:40Z
• Authors: William E. Rudgard; Carlton A. Evans; Sedona Sweeney; Tom Wingfield; Knut Lönnroth; Draurio Barreira; Delia Boccia
• Keywords: Cash transfers; Economic cost

Background Illness-related costs for patients with tuberculosis (TB) ≥20% of pre-illness annual household income predict adverse treatment outcomes and have been termed "catastrophic." Social protection initiatives, including cash transfers, are endorsed to help prevent catastrophic costs. With this aim, transfers may either be provided defray TB-related households a confirmed TB diagnosis (termed "TB-specific" approach); or increase high risk strengthen their economic resilience "TB-sensitive" approach). The impact each these approaches might vary. We undertook an modelling study from the patient perspective compare potential 2 transfer Methods findings Model inputs 7 low- middle-income countries (Brazil, Colombia, Ecuador, Ghana, Mexico, Tanzania, Yemen) were retrieved by literature review included countries' mean costs, income, estimated TB-specific TB-sensitive target populations. Analyses completed drug-susceptible (DS) in all out countries, additionally drug-resistant (DR) 1 available data. All cost data reported 2013 international dollars ($). population was poor diagnosis, already targeted established poverty-reduction programme. Cash offered unrelated TB, ranged $217 $1,091/year/household. Before DS 6 countries. If approach, alone they would insufficient 4 when increased enough require budget between $3.8 million (95% CI: million–$3.8 million) $75 $50 million–$100 per country. instead any $298 $219 million–$378 $165,367 $134,085 million–$196,425 DR before after Sensitivity analyses showed our robust imputation missing components, use 10% 30% 20% as threshold measuring Key limitations using national average not considering other health social benefits transfers. Conclusions A approach households' broad reducing poverty, but is unlikely effective affordable preventing only diagnosis. Preventing will considerable additional investment whether used.