Indirect patient expenses for antituberculosis treatment in Tijuana, Mexico: is treatment really free?

BACKGROUND One of the main problems faced by the Mexican National Tuberculosis Program is the high rate of patients abandoning treatment. This study aimed to determine the magnitude of unaccounted costs of tuberculosis (TB) treatment in Tijuana, Mexico. METHODOLOGY Subjects were recruited at 21 health centres. Patients had confirmed active pulmonary TB, had been on treatment for more than 12 weeks, and were aged 18 years and older. The questionnaire provided information about demographics, past and current episodes of TB, and various categories of expenses. RESULTS The study included 180 patients as follows: 48 had been diagnosed with tuberculosis in the past (26.6%) and had either currently relapsed or failed treatment; 160 (88.8%) were under directly observed therapy (DOT); 131 (72.8%) attended a health centre; and the rest received directly observed treatment at home. The daily cost of transportation to the health centre was MXN $25.88 +/- 3.22 (1 USD = 13 MXN). Thirty-two patients (17.8%) had to buy medication at least once, with a monthly medication expense of MXN $440.5 +/- 40.3. Patients receiving DOT at the health centre reported daily food and beverages expenses, spending MXN $56.5 +/- 10.1. Forty-two patients reported laboratory testing expenses, on average MXN $558.8 +/- 85.8 per month. Eighty patients (42.4%) reported expenses on radiographic/ultrasound studies, on average MXN $562.9 +/- 72.1 per six-month regimen. Conclusions TB diagnosis and treatment posed a significant economic burden on patients in terms of both cost and affordability; clinic-based DOT may contribute disproportionately to the costs incurred by patients.