Catastrophic costs of Tuberculosis in patients registered under the National Tuberculosis Elimination Programme in South-East Delhi, India

Background

Tuberculosis (TB) is one of the leading causes of death from an infectious agent. Tuberculosis patients often fall into a “poverty medical trap” due to the cost of treatment. The present study aimed to estimate the economic burden of TB in registered patients undergoing treatment under the national programme.

Methodology

The study was a mixed-method study conducted in various DOTS centres of South-East Delhi. Quantitative data collection was done using a validated questionnaire, while focus group discussions helped triangulate data generated by quantitative methods. Data on socio-demographics, disease-specific characteristics, and costs were gathered. Descriptive statistics delineated sample characteristics. Univariate analysis helped understand the factors influencing the catastrophic costs.

Results

A total of 439 Tuberculosis patients in the Intensive phase of treatment were approached, out of which 416 consented to participate in the study. The mean (±S.D) total costs were Rs. 5923 ± 1243.2 while the mean direct and indirect costs were Rs. 4553.6 ± 623.2 and Rs. 2475.4 ± 540.1, respectively. The total costs were significantly associated (p < 0.05) with the type of TB in the patient (more in EPTB patients), the type of health facility first visited (private more than government) and the employment status (highest cost in those who had employment of some kind). The catastrophic costs were experienced by 24.27 % of households.

Conclusion

Despite the free diagnosis and treatment of tuberculosis in the country, patients still experienced direct and indirect costs in the present study. More robust mechanisms and strategies are needed to reach the WHO End TB strategy target of ‘Zero Catastrophic Costs’.