ABSTRACT
La tuberculosis (TBC) es uno de los principales problemas de salud pública a nivel mundial. Argentina tiene una elevada tasa de incidencia de 30 por cada 100.000 habitantes. Hay datos sobre los costos directos de la tuberculosis, pero poco se conoce sobre su costo social. OBJETIVOS: explorar la relación entre percepción de enfermedad y costos intangibles de la TBC y medir el impacto del componente hogareño en el costo social de la TBC en el Área Metropolitana de Buenos Aires. Métodos : estudio descriptivo cualitativo y cuantitativo de la pérdida de calidad de vida y del costo social sobre una muestra de 30 pacientes con diagnóstico reciente de TBC y residentes en el Partido de Quilmes y 30 controles sanos. Las variables medidas fueron: costos intangibles o de pérdida de calidad de vida medidos con la encuesta SF-36, costos indirectos o de oportunidad y costos directos por atención de enfermedad. Resultados : para la pérdida de calidad de vida, tanto en casos como en controles, el puntaje promedio fue de 39 puntos en los tópicos generales de salud física y salud mental (escala 0 a 100). El costo social atribuible a la enfermedad alcanzó una suma de AR$ 597.78 por caso para el año 2007, con una participación de casi el 38% de la unidad doméstica. El costo estimado total país ascendió a AR$ 6.207.396,47. Conclusiones : en Argentina, la TBC está claramente vinculada con la vulnerabilidad socioeconómica. En las familias más pobres, la enfermedad impacta fuertemente en la unidad familiar, deteriorando una economía doméstica de por sí crítica
Tuberculosis (TB) is a major public health problem in the world. Argentina has a high rate of incidence of 30 cases per 100,000 inhabitants. There is information about direct costs of TB but little is known aboutits social costs. Objectives: To explore the relation ship between perception of disease and intangible costs; and to measure the impact of the house hold component on the social cost of the disease in the Metropolitan Area of Buenos Aires. Methods: quali-quantitative, descriptive study of the loss of quality of life and the TB social costs on a sample of 30 cases with TB living in Quilmes Partyand 30 controls. The variables included were intangible costs or loss of quality of life assessed through the SF-36survey, indirect or opportunity costs and direct costs of the disease health care. Results: for the loss of quality oflife, so cases as controls, the average score was 39 point sin the general issues of physics and mental health (scale 0 to 100). The social costs attributable to the disease reached a sum of AR$ 597.78 per case, with almost 38% paid from the house hold component. The estimated total country cost was AR$ 6.207.396.47 per year. Conclusions: In Argentina, TB is clearly associated to social-economy vulnerability. In poorest families, the disease strongly impacts on the family unit, worsening the already critic domestic economy
Subject(s)
Humans , Adult , Middle Aged , Cost of Illness , Data Collection , Direct Service Costs , Health Care Costs , Health-Disease Process , Quality of Life , Tuberculosis/economicsABSTRACT
Summary: Introduction. When the impact of illness is evaluated by indicators like mortality, mental illness has a less significant impact than other illnesses. As a result, the impact of mental disorders was underestimated until the last two decades of the previous century This perception began to change as a result of two factors: On the one hand, the study of the Global Burden of Disease reported by Murray and Lopez, and, on the other hand, the definition of mental disorders by the American Psychiatric Association. The common element shared by these two factors is the inclusion of the concept of disability. Disability is the deterioration of the expected functioning of a subject of a particular age and sex in a social context. It is a part of the social cost of illness. Objective. To assess the disability burden associated with depression, mania, agoraphobia, social phobia, general anxiety, panic disorder, and post-traumatic stress disorder (PTSD) according to the Mexican Psychiatric Survey and to compare results with the disability produced by some chronic non-psychiatric conditions. Method. This survey is based on a stratified, multistage area, probabilistic sample of adults living in urban areas of Mexico. The instrument used was the third version of the Composite International Diagnostic Interview. We report the 12-month prevalence of psychiatric disorders as defined by DSM-IV criteria. We also evaluated non-psychiatric chronic conditions like diabetes, arthritis, hypertension, backache, and other painful illnesses, identified in general as "chronic conditions". Indicators of disability were Sheehan's scale and number of work days lost. This is an easy and fast self reporting scale, which can be used both in the clinic or research. The sub-scales can be added or averaged to obtain a total score. The scale of responses is a horizontal line with numerals from 0 to 10 and five verbal descriptions, with the description "Not at all" corresponding to a value of 0; "Mild" rangimg from 1 to 3; "Moderate" from 4 to 6; "Severe" from 7 to 9; and "Very severe" corresponding to 10. Results. Close relationships and social life were the areas most deeply affected. The disorders found to produce the highest levels of disability were depression, social phobia, and PTSD. The lowest disability levels were observed in chronic conditions. On the total score of Sheehan's scale, disorders with the highest level of disability were PTSD (mean 5.35 ± 0.307) and depression (mean 4.72 ± 0.167). Depression and panic attacks were the disorders by which most days were lost on average in the previous year (25.51, CI95: 16.53-34.5; 20, CI95: 3.02-36.97). Days lost were lower in chronic conditions than in the seven mental disorders studied (6.89, CI95: 3.04-10.74). Discussion. This is the first paper to demonstrate the impact of mental disorders in Latin America evaluating the association of disability with common mental disorders. We have shown that mental disorders, especially depression, are associated with deficits in functioning and result in the loss of work days. We have also shown that persons with common mental disorders have, on average, higher levels of disability than those observed among persons with a wide range of chronic physical conditions. These results are consistent with prior studies in North America and Europe that have found that persons with common mental disorders experience substantial disability in social role functioning.
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