Patient-cost survey for tuberculosis in the context of patient-pathway modelling.

SETTING: Eight tuberculosis treatment sites in Cavite Province, the Philippines, including two sites specialising in management of multidrug-resistant tuberculosis (MDR-TB).OBJECTIVE: To evaluate costs incurred by TB patients and to determine the proportion of households that faced catastrophic costs, then to consider cost survey responses alongside results of detailed patient-pathway modelling.DESIGN: Clustered cross-sectional survey using a field testing version of the WHO TB patient-costing tool and protocol; face-to-face interviews with 194 patients conducted in May-August 2016. Costs included direct-medical, direct non-medical and indirect costs using the human capital approach. Patients were deemed to incur catastrophic expenditure if TB-related costs exceeded 20% of annual household income. Patient pathways were modelled following multiple health staff interviews.RESULTS: Estimated mean cost incurred by patients with drug-susceptible TB was US$321 vs. $2356 for MDR-TB patients. Catastrophic costs were suffered by 28% of drug-susceptible and 80% of MDR-TB patients, with lost income being the largest contributor. Patient-pathway modelling suggested most patients had under-reported health visits.CONCLUSION: Survey results indicate that patient costs are large for all patients in Cavite, particularly for MDR-TB patients. Patient-pathway modelling suggests these costs are an underestimate due to poor recollection of health visits, suggesting that the WHO instrument and protocol could be improved to better capture the diagnostic journey.

A comparison of felodipine and nifedipine as monotherapies for the treatment of mild to moderate hypertension.

We conducted a randomised double-blind crossover comparison of felodipine, 10 mg once daily, nifedipine 20 mg twice daily, each treatment being given as a monotherapy for four weeks. Active treatment was preceded by a two-week placebo run-in. Both systolic (SBP) and diastolic (DBP) blood pressures (supine and erect) fell significantly (all P less than 0.001) following both drug treatments. Nifedipine produced a greater orthostatic effect, and hence a significantly greater fall in erect SBP than felodipine (P less than 0.05). There was no significant difference between the effects of the drugs on DBP. Achieved DBP was 90 mmHg or less in 18/22 patients on felodipine and 18/22 patients on nifedipine. Both drugs were well-tolerated. Felodipine given once daily was effective as a monotherapy for the control of mild to moderate hypertension and compared favourably with twice daily nifedipine.