Economic Loss Analyses Due to Tuberculosis at Kolaka Regency in

South-East Sulawesi Province

La Ode Saafi*, La Ode Kamalia and Risal

STIKES Mandala Waluya Kendari Jalan Jend. AH. Nasution, Kec. Kambu, Kota Kendari, Sulawesi Tenggara 93561

Keywords: Tuberculosis, economic loss.

Abstract: Tuberculosis can cause pain and even death, as well as can cause psychosocial and economic problems. The

purpose of the study was to determine the economic losses due to tuberculosis in Kolaka Regency. This study

was an analytical survey, the sample was all tuberculosis patients in 2018. The indicators used to measure the

economics loss due to tuberculosis were government costs, household health costs, economic value of

productive time lost due to illness and death. Analysis of government and household costs were calculated

based on the cost component used for the treatment of tuberculosis, analysis of economic values due to illness

using the analysis of years life with disability (YLD) and economic value dies using years of life lost (YLL)

analysis amounting to Rp.452,482,857. Household health costs amounted to Rp.28, 699,500. Economic value

due to illness amounting to Rp.612, 068,012. While economic value died by tuberculosis in the amount of

Rp.4, 717,807,453. The total economic loss due to tuberculosis in Kolaka Regency during 2018 were Rp.

5,811,057,822.

1 INTRODUCTION

The main objective of the health development

program was to increase the equity and health efforts

that were successful and efficient and affordable by

all members of the community. One of which is an

effort to control and prevent tuberculosis that aims to

reduce the morbidity, mortality and cases of

tuberculosis and prevent the spread and reduce the

impact social and economic losses, so it does not

become a public health problem (Getahun et al.,

2016; Collins, Hafidz and Mustikawati, 2017).

Tuberculosis is an infectious disease caused by

microorganisms Mycobacterium tuberculosis which

mostly attacks lung organs in addition to other organs.

Tuberculosis is commonly found in developing

countries as a result of the country's inability to

provide adequate services in the field of health,

education, and socio-economic welfare to the

community (World Health Organization, 2012).

Based on the World Health Organization (WHO)

global report in 2018 at the global level it is estimated

that the number of new TB cases is as many as 3.2

million cases where most TB sufferers are of

productive age (15-55 years), in Indonesia (World

Health Organization, 2018).

Losses from the economic aspect can be caused

due to the costs incurred to tackle tuberculosis which

include: direct costs, indirect costs and household

costs. TB is also associated with economic lost, this

is caused because the population group of

economically productive age (15-59 years) around

75% who suffer from pulmonary tuberculosis

(Kementrian Kesehatan Republik Indonesia, 2019).

In Kolaka Regency in 2018 the number of positive

acid-resistant bacterial pulmonary tuberculosis

(BTA) sufferers was 235 with a case detection rate

(CDR) of 24% (Kolaka, 2017). Tuberculosis

treatment requires a long time period of 6-8 months

and requires a very high cost. However, until now

there has been no data regarding the real cost of

tuberculosis treatment. In fact, the data is needed to

provide input to policy makers in the framework of

budget planning to controlling and preventing

tuberculosis (Collins, Hafidz and Mustikawati, 2017).

This study wants to analyse the economic losses

due to tuberculosis in Kolaka Regency which carried

out treatment at puskesmas and hospitals. The choice

of calculating the economic burden derived by

tuberculosis patients and their family members is very

high, both direct costs from the government, but also

household health costs as well as the substantial loss

of income due to illness and death (Collins, Hafidz

148

Saaﬁ, L., Kamalia, L. and Risal, .

Economic Loss Analyses Due to Tuberculosis at Kolaka Regency in South-East Sulawesi Province.

DOI: 10.5220/0009125901480151

In Proceedings of the 2nd Health Science International Conference (HSIC 2019), pages 148-151

ISBN: 978-989-758-462-6

and Mustikawati, 2017). Based on the above, the

purpose of this study was to calculate the total

economic loss due to tuberculosis in Kolaka Regency

from the case finding to the end of treatment.

2 METHODS

This type of study was a descriptive study, which was

to analyse the estimated economic losses due to

tuberculosis in Kolaka Regency in 2018. This study

was carried out in 14 Puskesmas and 1 Hospitals,

spread over 12 District Areas in Kolaka Regency.

Data collection and analysis is conducted from May

to July 2019.

The population in the study were all patients with

tuberculosis in Kolaka Regency in 2018 totalling 235

people. The sampling method was census. Data

collection was done through observation, structured

interviews using interview instruments, and

collecting data through documentation that is looking

at documents that are related to this study. Data

obtained were analysed to determine government and

household health expenditures. The economic loss

due to illness and death were analysed by the

Disability Adjusted Life Years (DALY) method

(Murray et al., 2012).

3 RESULTS AND DISCUSSION

The socio-economic characteristics of tuberculosis

patients in this study indicate that 70% are male and

30% are female or the proportion of female patients

is 1: 2, 82% are aged 15-59 years, 47% work in the

informal sector like fishermen and farmers.

3.1 Government Budget for

Tuberculosis Control

The funding for tuberculosis treatment with the DOTS

program in Kolaka Regency is sourced from the

regional budget (APBD) of Rp. 297,477,857, - which

is focused on financing TB diagnosis and treatment

activities (Indonesia, 2018; World Health

Organization, 2018). While the funding for the TB

control program comes from the National Budget

(APBN) through the health operational assistance

fund (BOK) of Rp. 141,050,000, - which was used for

indirect activities for prevention and promotion, and

funding came from grants from the global TB

component fund of Rp. 13,955,000, - which is used for

program supervision and monitoring (Getahun et al.,

2016; Kementrian Kesehatan Republik Indonesia,

2019).

Efforts to tackle tuberculosis elimination are not

only enough to rely on the availability of service

personnel, adequate logistics and active involvement

of community participation, but also important is the

availability of adequate amounts of the budget. In

2018 the Kolaka Regency government allocated a

health budget for the prevention of diseases of Rp.

1,471,682,500, - while the budget for the tuberculosis

eradication program is Rp. 452,482,857, - then the

amount of the Kolaka District health budget for

efforts to control tuberculosis by 31%. This condition

is an illustration of how high the commitment of

policy makers (stakeholders) at various levels in

Kolaka Regency in organizing tuberculosis

prevention efforts.

3.2 Household Expenses of

Tuberculosis Cases

Costs incurred by households in the treatment of

tuberculosis patients obtained in this study consisted

of transport costs incurred by patients while

undergoing examinations and taking drugs at the

Puskesmas or Hospital. Transport costs obtained are

the real value of each patient's transport expenditure

then accumulated to Rp. 28,699,068. Household

expenditure from the point of view of service users is

the amount of funds that must be provided to be able

to use services, which are included in this expenditure

is every expenditure made by consumers in order to

obtain health services (Getahun et al., 2016; Collins,

Hafidz and Mustikawati, 2017).

In this study, the household costs that are

calculated are only expenses for transportation costs,

but fees for eating and drinking are not counted

because tuberculosis treatment services do not require

a long time. The results of an analysis conducted by

Gani (2000) in Yogyakarta Regency reported that

tuberculosis in Indonesia caused economic losses for

household expenditure of Rp. 25,021,947,850.

Compared to household expenditure due to

tuberculosis in Kolaka Regency, it can be seen that

the economic loss for household expenditure due to

tuberculosis is 0.14% of the total value of economic

losses for household expenditure due to tuberculosis

nationally (Kolaka, 2017).

Economic Loss Analyses Due to Tuberculosis at Kolaka Regency in South-East Sulawesi Province

149

3.3 The Economic Value of Productive

Time Lost Due to Suffering of

Tuberculosis

Costs of productivity or lost income are related to

losses incurred due to loss of work time due to

seeking treatment or stopping work due to illness.

Based on the results of this study it was found that the

total economic value due to illness was Rp.

612,068,012, - with 221 patients. Indicator of lost

productive time is how long productive time is lost

due to a person or group of people experiencing

illness, disability or death due to a certain health

problem (Getahun et al., 2016)

Income of patients with missing tuberculosis is

calculated during the examination period until the end

of treatment (success rate). In this study the patient

has passed the examination period for diagnosis and

at least has entered the final stage of the treatment

program. Calculation of income of patients who were

lost when taking anti-tuberculosis drugs and because

they stopped working due to tuberculosis and died

(Ahmad et al., 2009; Ayles et al., 2013; Collins,

Hafidz and Mustikawati, 2017).

In this study it was found that the majority of

sufferers' age groups were productive ages 15 - 59

years namely 182 people (82%) and the status of

patients was also mostly as heads of families i.e. 129

people (58%). This condition can give an illustration

that the sufferer's family will experience family

economic difficulties because the person suffering

from illness is the head of the family who acts as the

main focus of the family in earning a living as well as

other family members who fall into the age group of

workers (Ahmad et al., 2009; Nurjana, 2015).

The actual income of patients with pulmonary TB

an average of Rp. 1,622,872 per month or Rp.

19,474,462, - per year, as well as patients with

pulmonary TB who are sick will lose productive time

as much as 10,920 days (29.9 years). If converted into

rupiah value, the economic value can reach Rp.612,

068,012. Pulmonary TB patients who died also lost

productive time as much as 121,910 days or 334 years

whose economic value reached Rp. 4,717,807,453.

Thus, the economic value due to illness and death due

to pulmonary TB in Kolaka Regency in 2018 reached

Rp. 5,329,875,465

3.4 Economic Losses Due to Death of

Tuberculosis Patients

Patients with tuberculosis who died during 2018 in

Kolaka District were 14 people, by conducting the

Years of Life Lost (YLL) analysis, the economic loss

value of Rp. 4,717,807,453, - Economically, people

or people with tuberculosis who die will surely lose

their work opportunities or will be completely lost,

which in turn cannot earn income. The assumption of

the economic value of lost time can be interpreted as

the loss of one's income due to death.

In this study, the total economic loss of

tuberculosis patients was the total value of the

government budget allocation, household health

expenditure and the economic value of productive

time lost due to illness and death. The total losses

incurred due to tuberculosis in Kolaka Regency

amounted to Rp.5, 811,057,822.

4 CONCLUSIONS

Government health budget for medical expenses for

patients with pulmonary TB in the district of Kolaka

in 2018 amounting to Rp. 452,482,857. Household

expenditure for the treatment of pulmonary TB

patients in Kolaka Regency in 2018 amounting to Rp.

28,699,500. Costs lost (economic value) due to illness

by patients with pulmonary TB in Kolaka Regency in

2018 amounting to Rp. 612,068,012. Costs lost

(economic value) due to death before reaching an

average life expectancy due to pulmonary TB disease

of Rp. 4,717,807,453. Lung TB disease in Kolaka

Regency in 2018 caused a total economic loss of Rp.

5,811,057,822.

From this research, it can suggest that the amount

of economic losses caused by tuberculosis requires

serious efforts in controlling and preventing

tuberculosis. For policy makers to conduct a

financing analysis of tuberculosis disease control and

prevention programs so that the allocation of costs

can be maximized and utilized effectively and

efficiently.

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