Avaliação dos custos totais das famílias de pessoas com tuberculose por níveis de atenção à saúde no Brasil, 2019 - 2021

• Autor(a) principal: Negri, Letícya dos Santos Almeida
• Data de Publicação: 2021
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)
• Texto Completo: http://repositorio.ufes.br/handle/10/15158
• topic: Tuberculose; custo catastrófico; custos; OMS; pobreza; Brasil; subject.br-rjbn; Saúde Coletiva

Introduction: Tuberculosis is a serious public health problem and, associated with tuberculosis care, are the extra costs that patients and families incur, which can lead to economic hardship, impact on life and the outcome of the disease. Objective: To evaluate the total costs for families of people with tuberculosis in Brazil by level of health care, in the period from 2019 to 2021, to identify the impoverishment resulting from the diagnosis and treatment of tuberculosis. Method: Cross-sectional research, period from September 2019 to March 2021, in 35 municipalities in Brazil, with people diagnosed with tuberculosis. The instrument adapted for Brazil was used, following the World Health Organization protocol, version 2017. For continuous data, median, mean, and 95% confidence interval were used. For categorical data, absolute and relative frequencies were calculated. Multivariate logistic regression was used to determine associated factors. Statistical significance was defined with a p value < 0.05, and statistical analyses and data visualizations were performed using the statistical program R Studio, version14. McNemar's and Pearson's chi-square tests were used to assess the level of significance of the impoverishment variable before and after TB diagnosis and associations. All cost data were reported in international dollars, with a mean 2020 exchange rate change value of 5.16 Brazilian reals. Results: In Brazil, the costs faced by patients are high. Total medical costs were $1,553.00, of which $42 and $85 respectively in the pre-diagnosis and post-diagnosis of tuberculosis. The total cost is equivalent to 7.8 minimum wages on average and the average lost work time was 64.4 hours. The biggest drivers were food supplementation and travel for appointments. Most patients on TB treatment became impoverished after TB diagnosis. Conclusion: Although the service offered to tuberculosis patients in Brazil is free and provided by the public health system, patients incurred high costs, some factors are associated such as low education and not receiving benefits. Receiving emergency aid for Sars-CoV-2 during treatment was a protective factor for patients who impoverished. Identifying these barriers to costs incurred helps to assist in fostering a national policy to reduce costs for TB patients. Since most of the costs are indirect, it is about the effectiveness of the national police of food security, social assistance and employment and income, which already exist, but their action has been limited and insufficient in the face of the framework of social inequalities, poverty and priorities of the public agenda.