P162 Developing a tuberculosis patient cost survey adapted to the UK setting: recommendations from a national multi-sectoral workshop

Introduction and Objectives Even in countries such as the UK with free TB care, TB patients and their households can face catastrophic costs related to illness and seeking and obtaining care. Costs may be incurred indirectly (e.g. through lost work) or directly (e.g. travel costs). The WHO’s End TB Strategy targets elimination of catastrophic costs by 2030, calling for National TB Programmes to undertake country-level TB Patient Cost Surveys (TB-PCS) to determine the magnitude and drivers of costs; measure progress against global catastrophic cost indicators; and inform cost-mitigation interventions. Recognising its importance in the UK, a one-day national workshop was held In March 2019 to inform development of a UK TB-PCS. Methods 24 participants attended the workshop, including healthcare professionals, charities, TB-affected people, academics, and WHO and PHE policymakers. During the morning session research and experiences were shared from international TB-PCS implementations. In the afternoon session small working groups (facilitated by members of WHO’s Catastrophic Costs of TB Taskforce) explored key themes including: survey design and implementation; defining and calculating costs; estimating income and socioeconomic position; and potential linkage of electronic databases. Results Recommendations for refinements of WHO’s generic TB-PCS tool within the UK context were made and are summarised in the table 1. Longitudinal TB-PCS implementation with surveys at multiple time-points during treatment was supported by participants because of perceived improvements in the accuracy of estimated costs. Participants suggested the UK-specific expense and lost income calculations should include public transport and parking costs and types of employment (e.g. zero-hours vs salaried). Participants discussed the optimal methods for calculating socioeconomic position including alignment with validated national survey parameters and linkage of national health and economic databases. Finally, participants proposed measurement of coping strategies relevant to the UK including food-bank use, high-interest payday loans, sub-letting, and selling sex. Conclusions The recommendations of this national workshop are the basis for the development of a context-appropriate TB-PCS tool and protocol. Once funding is obtained, the first UK TB-PCS will be piloted and then implemented, which will inform WHO’s catastrophic costs indicator and provide much-needed estimates of the socioeconomic impact of TB in the UK.