{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T14:07:52Z","timestamp":1786457272783,"version":"build-2736575974"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T00:00:00Z","timestamp":1605139200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Tuberculosis (TB) patients incur large costs for care seeking, diagnosis, and treatment. To understand the magnitude of this financial burden and its main cost drivers, the Lao People\u2019s Democratic Republic (PDR) National TB Programme carried out the first national TB patient cost survey in 2018\u20132019.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>A facility-based cross-sectional survey was conducted based on a nationally representative sample of TB patients from public health facilities across 12 provinces. A total of 848 TB patients including 30 drug resistant (DR)-TB and 123 TB-HIV coinfected patients were interviewed using a standardised questionnaire developed by the World Health Organization. Information on direct medical, direct non-medical and indirect costs, as well as coping mechanisms was collected. We estimated the percentage of TB-affected households facing catastrophic costs, which was defined as total TB-related costs accounting for more than 20% of annual household income.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Result<\/jats:title>\n<jats:p>The median total cost of TB care was US$ 755 (Interquartile range 351\u20131,454). The costs were driven by direct non-medical costs (46.6%) and income loss (37.6%). Nutritional supplements accounted for 74.7% of direct non-medical costs. Half of the patients used savings, borrowed money or sold household assets to cope with TB. The proportion of unemployment more than doubled from 16.8% to 35.4% during the TB episode, especially among those working in the informal sector. Of all participants, 62.6% of TB-affected households faced catastrophic costs. This proportion was higher among households with DR-TB (86.7%) and TB-HIV coinfected patients (81.1%).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>In Lao PDR, TB patients and their households faced a substantial financial burden due to TB, despite the availability of free TB services in public health facilities. As direct non-medical and indirect costs were major cost drivers, providing free TB services is not enough to ease this financial burden. Expansion of existing social protection schemes to accommodate the needs of TB patients is necessary.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0241862","type":"journal-article","created":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T18:30:02Z","timestamp":1605205802000},"page":"e0241862","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":26,"title":["First national tuberculosis patient cost survey in Lao People\u2019s Democratic Republic: Assessment of the financial burden faced by TB-affected households and the comparisons by drug-resistance and HIV status"],"prefix":"10.1371","volume":"15","author":[{"given":"Phonenaly","family":"Chittamany","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0807-2370","authenticated-orcid":true,"given":"Takuya","family":"Yamanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakhone","family":"Suthepmany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thepphouthone","family":"Sorsavanh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phitsada","family":"Siphanthong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Sebert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerri","family":"Viney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thipphasone","family":"Vixaysouk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moeko","family":"Nagai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vilath","family":"Seevisay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyohiko","family":"Izumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fukushi","family":"Morishita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Nishikiori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,11,12]]},"reference":[{"key":"pone.0241862.ref001","unstructured":"The World Health Organization. Global Tuberculosis Report 2018. 2018."},{"issue":"4","key":"pone.0241862.ref002","doi-asserted-by":"crossref","first-page":"654","DOI":"10.2105\/AJPH.2010.199505","article-title":"The social determinants of tuberculosis: from evidence to action","volume":"101","author":"JR Hargreaves","year":"2011","journal-title":"Am J Public Health"},{"issue":"7","key":"pone.0241862.ref003","doi-asserted-by":"crossref","first-page":"e1001675","DOI":"10.1371\/journal.pmed.1001675","article-title":"Defining catastrophic costs and comparing their importance for adverse tuberculosis outcome with multi-drug resistance: a prospective cohort study, Peru","volume":"11","author":"T Wingfield","year":"2014","journal-title":"PLoS Med"},{"issue":"5","key":"pone.0241862.ref004","doi-asserted-by":"crossref","first-page":"e514","DOI":"10.1016\/S2214-109X(18)30195-5","article-title":"The impact of social protection and poverty elimination on global tuberculosis incidence: a statistical modelling analysis of Sustainable Development Goal 1","volume":"6","author":"DJ Carter","year":"2018","journal-title":"The Lancet Global Health"},{"key":"pone.0241862.ref005","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.socscimed.2015.01.046","article-title":"The economic burden of TB diagnosis and treatment in South Africa","volume":"130","author":"N Foster","year":"2015","journal-title":"Soc Sci Med"},{"issue":"6","key":"pone.0241862.ref006","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1183\/09031936.00193413","article-title":"Financial burden for tuberculosis patients in low- and middle-income countries: a systematic review","volume":"43","author":"T Tanimura","year":"2014","journal-title":"Eur Respir J"},{"issue":"9","key":"pone.0241862.ref007","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1007\/s40273-015-0279-6","article-title":"Costs to Health Services and the Patient of Treating Tuberculosis: A Systematic Literature Review","volume":"33","author":"YV Laurence","year":"2015","journal-title":"Pharmacoeconomics"},{"issue":"3","key":"pone.0241862.ref008","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/0277-9536(95)00375-4","article-title":"Household strategies to cope with the economic costs of illness","author":"R Sauerborn","year":"1996","journal-title":"Soc Sci Med"},{"issue":"6","key":"pone.0241862.ref009","doi-asserted-by":"crossref","first-page":"449","DOI":"10.2471\/BLT.12.115428","article-title":"Self-reported illness and household strategies for coping with health-care payments in Bangladesh","volume":"91","author":"MM Rahman","year":"2013","journal-title":"Bull World Health Organ"},{"issue":"suppl_4","key":"pone.0241862.ref010","doi-asserted-by":"crossref","first-page":"iv48","DOI":"10.1093\/heapol\/czw183","article-title":"The patient costs of care for those with TB and HIV: a cross-sectional study from South Africa","volume":"32","author":"D Mudzengi","year":"2017","journal-title":"Health Policy Plan"},{"key":"pone.0241862.ref011","unstructured":"The World Health Organization. The End TB Strategy. 2013."},{"key":"pone.0241862.ref012","unstructured":"The World Health Organization. Patient Cost Surveys: Handbook. 2017."},{"key":"pone.0241862.ref013","unstructured":"The World Health Organization. Regional Framework for Action on Implementation of the End TB Strategy in the Western Pacific, 2016\u20132020. 2016."},{"key":"pone.0241862.ref014","unstructured":"Ministry of Health Lao PDR. Ministry of Health National Tuberculosis Control Programme National TB Strategic Plan Update 2017\u201320. 2017."},{"key":"pone.0241862.ref015","unstructured":"The World Health Organization. Lao People's Democratic Republic Health System Review. 2014."},{"key":"pone.0241862.ref016","unstructured":"Central Intelligence Agency. The world fact book: East and southeast asia, Laos. 2018."},{"key":"pone.0241862.ref017","unstructured":"World Bank. Rural population (% of total population). 2014."},{"key":"pone.0241862.ref018","unstructured":"Lao Statistics Bureau. The 4th Population and Housing Census (PHC) 2015. 2015."},{"key":"pone.0241862.ref019","unstructured":"World Bank. Country Profile: Lao PDR. 2016."},{"issue":"9","key":"pone.0241862.ref020","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1111\/tmi.12536","article-title":"The first national tuberculosis prevalence survey of Lao PDR (2010\u20132011)","volume":"20","author":"I Law","year":"2015","journal-title":"Trop Med Int Health"},{"key":"pone.0241862.ref021","unstructured":"The World Health Organization. Global Tuberculosis Report 2019. 2019."},{"key":"pone.0241862.ref022","unstructured":"National Assembly Lao PDR. Law on Social Security. 2013."},{"key":"pone.0241862.ref023","unstructured":"National Health Insurance Bureau Ministry of Health Lao PDR. National Health Insurance Strategy 2017\u20132020. 2017."},{"key":"pone.0241862.ref024","unstructured":"Ministry of Health Lao PDR. National Health Accounts Report: Fiscal Years 2012\u20132013, 2013\u20132014, 2014\u20132015, and 2015\u20132016. 2017."},{"key":"pone.0241862.ref025","unstructured":"Ministry of Health Lao PDR. Essential Health Service Packages 2018\u20132020. 2018."},{"key":"pone.0241862.ref026","unstructured":"UNAIDS. Lao PDR country progress report: Global AIDS Response Progress Country Report, 2016. 2016."},{"issue":"Suppl 1","key":"pone.0241862.ref027","doi-asserted-by":"crossref","first-page":"i37","DOI":"10.1093\/heapol\/czq056","article-title":"Critical interactions between Global Fund-supported programmes and health systems: a case study in Lao People's Democratic Republic","volume":"25","author":"S Mounier-Jack","year":"2010","journal-title":"Health Policy Plan"},{"key":"pone.0241862.ref028","unstructured":"Government of the Lao People\u2019s Democratic Republic, The Ministry of Health DoCDC, The National Tuberculosis Centre, The Centre for HIV\/AIDS and STI. The Joint Programme Review of the Health Sector Response to Tuberculosis and HIV\/AIDS in Lao People\u2019s Democratic Republic, December 2019. 2019."},{"issue":"2","key":"pone.0241862.ref029","article-title":"The Financial Burden of Tuberculosis for Patients in the Western-Pacific Region","volume":"4","author":"K Viney","year":"2019","journal-title":"Trop Med Infect Dis"},{"key":"pone.0241862.ref030","unstructured":"Ona. Ona. Available from: https:\/\/ona.io\/home\/."},{"key":"pone.0241862.ref031","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1186\/s12913-015-1138-z","article-title":"What can dissaving tell us about catastrophic costs? Linear and logistic regression analysis of the relationship between patient costs and financial coping strategies adopted by tuberculosis patients in Bangladesh, Tanzania and Bangalore, India","volume":"15","author":"J Madan","year":"2015","journal-title":"BMC Health Serv Res"},{"issue":"9","key":"pone.0241862.ref032","doi-asserted-by":"crossref","first-page":"983","DOI":"10.5588\/ijtld.17.0859","article-title":"Measuring catastrophic costs due to tuberculosis in Viet Nam","volume":"22","author":"NV Nhung","year":"2018","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0241862.ref033","unstructured":"Cegielski. JP, McMurray. DN. The relationship between malnutrition and tuberculosis evidence from studies in humans and experimental animals. 2004."},{"issue":"3","key":"pone.0241862.ref034","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.nut.2005.06.009","article-title":"Body composition studies in patients with wasting associated with tuberculosis","volume":"22","author":"NI Paton","year":"2006","journal-title":"Nutrition"},{"issue":"4_suppl4","key":"pone.0241862.ref035","doi-asserted-by":"crossref","first-page":"S345","DOI":"10.1177\/15648265100314S404","article-title":"Addressing Tuberculosis in the Context of Malnutrition and HIV Coinfection","volume":"31","author":"RD Semba","year":"2010","journal-title":"Food and Nutrition Bulletin"},{"issue":"1","key":"pone.0241862.ref036","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1093\/ije\/dyp308","article-title":"A consistent log-linear relationship between tuberculosis incidence and body mass index","volume":"39","author":"K Lonnroth","year":"2010","journal-title":"Int J Epidemiol"},{"issue":"1","key":"pone.0241862.ref037","doi-asserted-by":"crossref","first-page":"11","DOI":"10.4103\/0971-5916.193278","article-title":"Undernutrition & tuberculosis in India: Situation analysis & the way forward","volume":"144","author":"C Padmapriyadarsini","year":"2016","journal-title":"Indian J Med Res"},{"issue":"2011","key":"pone.0241862.ref038","article-title":"Knowledge and awareness of tuberculosis among Roma population in Belgrade: a qualitative study","volume":"284","author":"DS Vukovic","year":"2011","journal-title":"BMC Infectious Diseases"},{"key":"pone.0241862.ref039","unstructured":"Ministry of Health Kenya. The First Kenya Tuberculosis Patient Cost Survey. 2018."},{"issue":"9","key":"pone.0241862.ref040","doi-asserted-by":"crossref","first-page":"e0162796","DOI":"10.1371\/journal.pone.0162796","article-title":"Mitigating Financial Burden of Tuberculosis through Active Case Finding Targeting Household and Neighbourhood Contacts in Cambodia","volume":"11","author":"F Morishita","year":"2016","journal-title":"PLoS One"},{"key":"pone.0241862.ref041","unstructured":"The World Health Organization. Guideline: Nutritional care and support for patients with tuberculosis. Geneva: World Health Organization: 2013."},{"key":"pone.0241862.ref042","unstructured":"National Nutrition Center MoHLP. National Nutrition Strategy to 2025 and Plan of Action 2016\u20132020. 2016."},{"issue":"11","key":"pone.0241862.ref043","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.5588\/ijtld.18.0765","article-title":"Four of five tuberculosis patients experience catastrophic costs related to TB diagnosis and care in Timor-Leste","volume":"23","author":"K Viney","year":"2019","journal-title":"Int J Tuberc Lung Dis"},{"issue":"8","key":"pone.0241862.ref044","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1111\/tmi.13085","article-title":"How affordable is TB care? Findings from a nationwide TB patient cost survey in Ghana","volume":"23","author":"D Pedrazzoli","year":"2018","journal-title":"Trop Med Int Health"},{"key":"pone.0241862.ref045","doi-asserted-by":"crossref","first-page":"23515","DOI":"10.3402\/ijch.v73.23515","article-title":"A comparison between passive and active case finding in TB control in the Arkhangelsk region","volume":"73","author":"VN Kuznetsov","year":"2014","journal-title":"Int J Circumpolar Health"},{"issue":"6","key":"pone.0241862.ref046","doi-asserted-by":"crossref","first-page":"828","DOI":"10.5588\/ijtld.11.0688","article-title":"Non-hospital DOT and early diagnosis of tuberculosis reduce costs while achieving treatment success","volume":"16","author":"K Pichenda","year":"2012","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0241862.ref047","unstructured":"Viet Nam News. SMS campaign to help TB patients. 2018."},{"issue":"1","key":"pone.0241862.ref048","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12890-018-0777-3","article-title":"TB sequel: incidence, pathogenesis and risk factors of long-term medical and social sequelae of pulmonary TB\u2014a study protocol","volume":"19","author":"A Rachow","year":"2019","journal-title":"BMC Pulm Med"},{"key":"pone.0241862.ref049","unstructured":"National Assembly Lao PDR. Law on HIV\/AIDS Control and Prevention. 2010."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0241862","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T18:31:11Z","timestamp":1605205871000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0241862"}},"subtitle":[],"editor":[{"given":"Tom E.","family":"Wingfield","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2020,11,12]]},"references-count":49,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0241862","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,12]]}}}