Effect of Poverty and Rural Settings on Catastrophic Expenditure in Multi-Drug-Resistant Tuberculosis: An Exploratory Study using Propensity Score Matching.

Background: A person having multi-drug-resistant tuberculosis (MDR-TB) may have co-payments and deductibles rendered into the out-of-pocket and catastrophic expenditure. This study explores whether catastrophic expenditure is associated with income and place of residence amongst MDR-TB patients after adjusting covariables through propensity score matching. We further explore the origin, distribution, and dominant components of costs across the four strata created by income and place of residence. Material and Methods: This cross-sectional study was conducted among MDR-TB patients registered in DTC Bhopal, MP, India, in calendar year 2017. Information on socio-demographic profile, various costs, and adapted coping strategy was collected through a structured instrument. Total expenditure of 20% or more of household income was considered as catastrophic cutoff. Catastrophic health expenditure (CHE) was regressed on binary income category and place of residence as predictor for CHE after adjusting covariates through cohort balancing. Results: For income category, 74 observations (33 in non-CHE category with 41 CHE category participants) matched with each other. While for place of residence, 98 observations (40 in non-CHE category with 58 from CHE category) matched with each other. Being in low-income group had an incremental odds ratio of 8.57 (95% CI 2.73-33.77) for CHE while odds of incurring CHE were 10 times higher (OR = 10.51, 95% CI 2.24-128.37) in rural area. Nutritional supplements and ancillary medication shared the major proportion of CHE costs in all the strata. Conclusions: Income and geographical disparity in MDR may increase probability of catastrophic expenditure in MDR-TB.