Study highlights 'catastrophic costs' incurred by tuberculosis patients worldwide

New Delhi: Tuberculosis patients across the world incur "catastrophic" costs despite many countries providing free treatment, with hospitalisation and loss of income being the major drivers, according to an analysis of previously published studies. Researchers, including those from the University of Ottawa, said that patients incurring catastrophic costs are two to four times more likely to experience treatment failure.

Therefore, mitigating treatment costs will not only benefit individuals, but also health systems and communities at large, they said.

Tuberculosis is a bacterial disease that spreads through the air when an infected person coughs or sneezes. Symptoms include a persistent cough, chest pain, fever, fatigue, among others.


Findings, published in the journal PLOS Global Public Health, also showed that costs were consistently higher among patients having drug resistant tuberculosis and those identified through 'passive case finding'.

The researchers suggested that actively finding cases, along with improving access to tests for drug resistant tuberculosis, may help mitigate the burden of out-of-pocket expenditures incurred by patients.

The World Health Organization's 'End TB' strategy envisages to "eliminate catastrophic costs for TB-affected households by 2030".

Adopted by the World Health Assembly in 2014, the strategy serves as a blueprint for bringing down tuberculosis incidence by 80 per cent, and deaths by 90 per cent, by 2030.

However, the study's findings have demonstrated that "free" TB care under national programs is not adequate to prevent patients from facing severe financial burdens during diagnosis and treatment.

India's 'National TB Elimination Programme' provides free diagnosis and subsidised care, according to the Ministry of Health and Family Welfare.

For the analysis, the researchers reviewed 76 studies, most of which were conducted in Asian and African countries, across urban and rural settings. Majority of the studies were also published in the past five years.

On average, tuberculosis care was estimated to cost up to over USD 11,000 -- pre-diagnosis costs ranged from USD 30 to USD 1,400, while post-diagnosis care could cost up to USD 5,200.

"Costs were consistently higher amongst persons with drug resistant TB (tuberculosis) and those identified through passive case finding. Hospitalisation and loss of income were the largest drivers of cost," the authors wrote.

"Despite many countries offering free TB treatment, patients still incurred significant catastrophic costs," they wrote.

The researchers said that the high costs can result in patients resorting to coping mechanisms, including selling assets, using savings and borrowing money.

The team suggested that complementary social protection and financial support policies and systems should be further developed and implemented, alongside of standard TB programs to protect patients from the burden of out-of-pocket expenses.

Understanding factors that influence patient costs can help with developing tailored strategies and policies for social protection and providing effective TB care resources, the authors said.

Brazil's 'Bolsa Familia Program' -- one of world's largest conditional cash transfer programmes -- was responsible for slashing tuberculosis cases and deaths among those living in extreme poverty and indigenous groups by more than half, according to a study coordinated by the Barcelona Institute for Global Health, Spain, and published in January in Nature Medicine.