%0 Journal Article
%T Patient medical costs for tuberculosis treatment and impact on adherence in China: a systematic review
%A Qian Long
%A Helen Smith
%A Tuohong Zhang
%A Shenglan Tang
%A Paul Garner
%J BMC Public Health
%D 2011
%I BioMed Central
%R 10.1186/1471-2458-11-393
%X Inclusion criteria were primary research studies, including surveys and studies using qualitative methods, conducted in mainland China. We searched MEDLINE, PUBMED, EMBASE, Science Direct, HEED, CNKI to June 2010; and web pages of relevant Chinese and international organisations. Cost estimates were extracted, transformed, and expressed in absolute values and as a percentage of household income.Low income patients, defined at household or district level, pay a total of US$ 149 to 724 (RMB 1241 to 5228) for medical costs for a treatment course; as a percentage of annual household income, estimates range from 42% to 119%. One national survey showed 73% of TB patients at the time of the survey had interrupted or suspended treatment, and estimates from 9 smaller more recent studies showed that the proportion of patients at the time of the survey who had run out of drugs or were not taking them ranged from 3 to 25%. Synthesis of surveys and qualitative research indicate that cost is the most cited reason for default.Despite a policy of free drug treatment for TB in China, health services charge all income groups, and costs are high. Adherence measured in cross sectional surveys is often low, and the cumulative failure to adhere is likely to be much higher. These findings may be relevant to those concerned with the development and spread of multi-drug resistant TB. New strategies need to take this into account and ensure patient adherence.In China, over 130,000 people die from tuberculosis (TB) each year [1]. In 2004, 140,000 people were estimated to have multidrug resistant tuberculosis (MDR TB), about one third of the total worldwide [2]. It is therefore particularly important that the health system ensures the delivery of full treatment to those with the disease.China's health system was decentralised in the 1980's, and the central government budget for health facilities dropped to 10% of the total facilities' revenue by the early 1990s [3]. Health services were expect
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