A comparative study of out-of-pocket expenditure and quality of life in chronic pulmonary aspergillosis and post-tuberculosis lung disease patients.

BACKGROUND

Chronic pulmonary aspergillosis (CPA) comprises a spectrum of conditions that frequently affect individuals with chronic lung diseases, particularly post-tuberculosis lung disease (PTLD). Both disorders contribute to significant morbidity and impaired quality of life (QoL). In addition, they impose financial burden, much of which is borne directly by patients in low- and middle-income countries. However, data on out-of-pocket expenditure (OOPE) and its relationship with QoL in these groups remain limited.

METHODS

This cross-sectional study, conducted at a tertiary referral centre in India, aimed to estimate OOPE (direct and indirect costs) in patients with CPA and PTLD, identify determinants of expenditure, and assess associations with QoL. Data on OOPE, borrowing, and catastrophic health expenditure during the preceding year were collected through structured interviews. QoL was evaluated using the St. George's Respiratory Questionnaire (SGRQ).

RESULTS

Both the direct ($406.42 ± 543.95 vs $251.81 ± 245.42, p value: 0.0038) and indirect costs ($49.93 ± 72.07 vs $39.81 ± 123.32, p value: 0.001) were significantly higher in the CPA group compared with the PTLD group. Subgroup analyses revealed higher diagnostic, transport, and food-related expenses in CPA individuals. Catastrophic expenditure was comparable in both groups (CPA: 60.5 %; PTLD: 67.9 %; p:0.325). Hemoptysis independently predicted poorer QoL across groups. QoL was significantly worse in CPA than PTLD (SGRQ total: 37.32 vs 31.16, p: 0.0125) and significant correlation between OOPE and QoL.

CONCLUSION

CPA imposes a greater financial burden and is associated with a poorer QoL compared with PTLD, underscoring the need for financial protection measures to improve outcomes in these patients.