Impact of financial support on treatment outcomes of multidrug-resistant tuberculosis: a population-based, retrospective cohort study in China

Abstract Background To date, the treatment success rate of Multidrug-resistant tuberculosis (MDR-TB) is low. The prolonged treatment course and expensive second-line anti-tuberculosis drugs (SLDs) for treating MDR-TB could lead to heavy financial expenditure. This economic barrier might result in poor adherence, lost to follow-up and treatment failure. Therefore, provision of financial support might improve treatment outcomes of MDR-TB. This study investigated the association between a subsidy policy and treatment outcomes of MDR-TB patients. Methods In this population-based, retrospective study, demographic, clinical characteristics, and the drug susceptibility profiles of all registered MDR-TB patients between 2011 and 2019 in Shanghai, China were collected. In total, 865 of 1016 patients were eligible for analysis, among which 70.6% (611/865) had treatment success. Information on the subsidies for MDR-TB treatment, which was in addition to the basic health insurance, were routinely recorded by the end of December 2021. Multivariate logistic regression adjusted for potential confounders was performed to evaluate the association between the situation of subsidies and treatment outcomes by estimating odds ratios (ORs) and 95% confidence intervals (CIs). The effect of greater/less subsidies on outcomes was further assessed using the median amount of financial support as cut-off points. Results During the study period, 74.1% (641/856) patients received subsidies for MDR-TB treatment. The median subsidies received across the treatment course was 15026 (Interquartile range, IQR, 7107–36001) Chinese Yuan (CNY), of which the reimbursement for SLDs were the major components. Those who had treatment success received significantly more subsidies (median, 17836 CNY) compared with patients with adverse outcomes (9794 CNY, P < 0.001). Benefiting from the subsidy policy was positively associated with treatment success, with an adjusted odds ratio (OR) equal to 2.95 (95% confidence interval [CI], 2.03–4.28). Among 641 patients who received subsidies, the OR comparing those with greater and less reimbursement was 1.74 (95% CI, 1.16–2.61). Additional adjustment for baseline drug-resistance did not alter these results. Conclusions Financial support was positively associated with better treatment outcomes among MDR-TB patients. Results in this study call for further financial assistance to facilitate appropriate medical care and to improve treatment outcomes of MDR-TB.