6. Survey of costs faced by households affected by tuberculosis, %%YEAR%%
6.1. TB-affected households facing total costs >20% of household income due to TB
6.1.1 Percentage of TB-affected households facing total costs >20% of annual household income due to TB by type of treatment
6.1.2 Percentage of TB-affected households facing total costs >20% of annual household income due to TB by income quintile
6.1.3 Total cost incurred by TB-affected households during one TB episode in US$
6.1.4 Distribution of total TB cost by cost category
6.2. Individual household income and poverty rate
6.2.1 Mean self-reported monthly household income before and during TB episode in US$
6.2.2 Changes in distribution of monthly self-reported household income by household income quintile before TB episode
6.2.3 Mean self-reported monthly household income before TB episode in US$
6.2.4 Mean self-reported monthly household income during TB episode in US$
6.2.5 Percentage of TB-affected households living below international poverty line
6.2.6 Percentage of TB-affected households living below international poverty line during TB episode by income quintile
6.2.7 Percentage of people with unemployment before and during TB episode
6.3. Coping mechanisms and social consequences
6.3.1 Percentage of TB-affected households that adopted coping mechanisms
6.3.2 TB Percentage of TB-affected households that adopted coping mechanisms by type of treatment
6.3.3 Percentage of TB-affected households experiencing social consequences
6.3.4 Percentage of TB-affected households experiencing social consequences by type of treatment
6.3.5 Percentage of people treated for TB received social support, overall
6.3.6 Percentage of people treated for TB receiving social support by type of treatment
6.4. Risk factors of facing costs >20% of household annual income due to TB
6.4.1 Odds ratio of the association between income quintiles and the likelihood of facing total costs >20% of household annual income due to TB
6.4.2 Odds ratio of the association between hospitalization and the likelihood of facing total costs >20% of household annual income due to TB
6.4.3 Odds ratio of the association between employment status and the likelihood of facing total costs >20% of household annual income due to TB
6.4.4 Odds ratio of the association between TB treatment type and the likelihood of facing total costs >20% of household annual income due to TB
6.4.5 Odds ratio of the association between treatment support type and the likelihood of facing total costs >20% of household income due to TB
6.4.6 Odds ratio of the association between being primary earner and the likelihood of facing total costs >20% of household income due to TB
6.5. Other
6.5.1 Percentage of people with diagnostic delay over 4 weeks
Metadata
Glossary and definitions
| Percentage of TB-affected households facing total costs >20% of annual household income due to TB (one of the three high-level target indicators of the end TB Strategy) | Total costs borne by people treated for TB and their households that exceed 20% of the household’s annual disease income. Total costs correspond to the sum of direct medical expenditures, direct non-medical expenditures and indirect costs (e.g. income losses). |
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| Coping mechanisms and strategies | The indicator “coping mechanisms” is tracked in surveys of costs incurred by people treated for TB and their households (TB household cost surveys); it refers to taking loans or selling household assets, or a combination of the two strategies. Surveys implemented using 2015 methodology tracked four indicators for coping mechanisms: dissaving, taking loans or selling household assets, or a combination of the three strategies. Surveys that followed the methods set out in the World Health Organization (WHO) handbook and that used (with adaptation) the associated 2017 generic instrument collected data about three main strategies: taking loans or selling household assets, or a combination of the two strategies. |
| Direct medical costs | Payments made by people treated for TB and their households for medical services (e.g. consultations, diagnostic tests, medicines and other medical procedures), net of any reimbursements. |
| Direct nonmedical costs | Payments made by people treated for TB and their households not directly related to medical care but are nonetheless linked to the process of seeking, receiving, and adhering to TB treatment, net of any reimbursements. These include: A. expenses related to travel to and from health facilities including transportation, food and accommodation; and B. additional expenditure on food or nutritional supplements to meet the increased dietary needs during TB treatment. |
| Household | A small group of people who share the same living accommodation, who pool some, or all, of their income and wealth, and who consume certain types of goods and services collectively (mainly housing and food). |
| Household income | The amount of money received by a household during the reference period in exchange for labour or services, from the sale of goods or property, or as a profit from financial investments. TB household cost surveys collect self-reported household income over the TB episode (e.g. before TB, at the time of TB diagnosis and during the TB episode). This indicator corresponds “current income”. |
| Indirect costs of care seeking and TB treatment | The income or time that a person on TB treatment or their household report losing as a result of TB health care visits and hospitalization during the TB episode. Indirect costs are estimated using two alternative methods: • self-reported household income loss, net of welfare payments (i.e the net effect of income change comparing income before the current TB episode with that during the episode); and • the total period of time spent seeking care in hours multiplied by the individual’s hourly wage rate. |
| Odds ratio of the association between the risk factors and the likelihood of facing total cost >20% of household income due to TB | The Odds Ratio (OR) is a statistical measure used to determine the strength of association between two events, commonly used in medical, epidemiological, and social sciences research. Odds Ratio compares the odds of an outcome occurring in an exposed group to the odds of the same outcome occurring in a non-exposed (or control) group. The formula to compute crude odds ratio is OR= (a/b) / (c/d). Where: a is the number of study participants/their households who have both the exposure and facing costs >20% of household annual income or expenditure due to TB; b is the number of study participants with the exposure but didn't face costs >20% of household annual income or expenditure due to TB; c is the number of study participants without the exposure but faced costs >20% of household annual income or expenditure due to TB; d is the number of study participants with neither the exposure nor facing costs >20% of household income or expenditure due to TB. However, patient cost survey applies multivariate logistic regression modeling to derive adjusted odds ratio. |
| Social consequences | The indicator “social consequences” refers to the negative social impacts experienced by people treated for TB and their households. The survey instrument collected data for the following social sequences: divorce, interrupted schooling, food insecurity, job loss and social exclusion. |
| TB-affected households living below international poverty line | TB household cost surveys evaluated household poverty rates by comparing respondent’s daily income against the international poverty threshold of US$ 1.90 at purchasing power parity adjusted dollars. The threshold was converted to the respective local currency units using the 2011 purchasing parity exchange rate, and then inflated using the ratio of changes in values of the annual consumer price index (reported in the international finance statistics database) in the year of the survey compared with 2011. |
| Glossary and data source referenced | National surveys of costs faced by tuberculosis patients and their households 2015–2021. Geneva: World Health Organization; 2022 (https://iris.who.int/handle/10665/366277). This book provides comprehensive documentation about 20 national surveys of costs faced by TB patients and their households that were completed between 2015 and 2021, according to WHO-recommended methods. |
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