Background: To understand the impact of extrapulmonary tuberculosis (EPTB) and its treatment on quality of life, we analysed patient-reported outcome measures (PROMs) among presumptive ETPB patients.
Methods: EuroQol's five-dimensional three-level (EQ-5D-3L) questionnaire and the Visual Analogue Scale (EQ-VAS) were used to measure PROMs by 274 presumptive EPTB patients at pre- and post-treatment stages. The patients were categorised as TB and non-TB by using a composite reference standard. Following the EuroQol suggested analysis methods, we calculated the health utility summary measure at the pre- and post-treatment stages. The health state density curve and index were used to analyse inequality in reported health profiles. We investigated factors associated with EPTB patients' health utility through multivariable regression at the pre-treatment stage.
Results: The analysis of PROMs showed both physical (mobility, self-care, usual activities) and psychological (pain, discomfort, anxiety & depression) health affected by all EPTB manifestations (lymphadenitis, pleuritis, meningitis and others). Moreover, we found inequality in reported health profiles across disease manifestations at pre- and post-treatment stages. Post-treatment, we found improvement in PROMs and no reports of extreme-level health problems. However, some problems persisted across all dimensions of EPTB manifestations. We found 100% improvement in pleuritis and meningitis manifestations. Socioeconomic status, type of health facility attended, and patients' working capacity were associated with health utility.
Conclusion: Despite post-treatment improvement in health, inequality of reported health states by EPTB manifestations persisted, though decreased. This highlights that holistic patient- and health system-level interventions addressing the impact of illness should consider EPTB by its manifestations, not as a single disease entity.
Keywords: EPTB; Extrapulmonary Tuberculosis; HRQoL; Inequalities; PROMs; Quality of Life.
Extrapulmonary tuberculosis (EPTB) is a relatively less lethal disease than pulmonary tuberculosis. However, it carries other challenges, such as signs and symptoms that mimic other diseases, adding to its challenges in prompt diagnostic confirmation. Because ETPB is not readily transmissible to other patients and is less lethal, it has been ignored in public health policies and research. Eventually, to date, little to no information is available about its impact on patients’ quality of life. This study indicates that the known clinical manifestations of EPTB vary in their effect on health-related quality of life, including physical and psychosocial health. Similarly, despite successful completion of EPTB treatment, the maximum level of health was not achieved among all patients. Some patients still reported physical and psychosocial problems. This means that EPTB patients may still need support for their physical and psychosocial health after completing their medical treatment. Therefore, public health policy should also consider EPTB for its impact on quality of life. Moreover, EPTB should not be perceived as a single disease as its impact varies based on clinical manifestations.
© 2024. The Author(s).