Despite treatment under National Elimination Program, people incur ‘catastrophic’ costs on TB

Despite free tuberculosis diagnosis and treatment under India’s National TB Elimination Program, nearly half the infected people incur “catastrophic” costs due to a loss in wages and hospitalisation, a study has found.

Published in the journal Global Health Research and Policy, the research estimated that typically, tuberculosis treatment and care costs a total of USD 386 for an individual.

The National TB Elimination Program (NTEP) is aimed at achieving a TB-free India by 2025, while the World Health Organization’s (WHO) ‘End TB Strategy’ targets 2035 to end the global epidemic.

Researchers from the TB Support Network, WHO Country Office for India, New Delhi, and Indian Council for Medical Research-National Institute of Epidemiology, Tamil Nadu, interviewed over 1,400 infected people notified under the National TB Elimination Program, and whose treatment outcome was declared between May 2022 and February 2023.

“Persons with TB (PwTB) in India incur high costs mainly due to lost productivity and hospitalisation. Nearly half of them experience catastrophic costs, especially those from poorer economic quintiles,”
the authors wrote.

Direct costs — incurred mostly before diagnosis or during hospitalisation- were found to account for 34 per cent of the total costs (about USD 78), while indirect ones typically were found to be almost USD 280.

Indirect costs due to loss of wages or productivity were found to contribute more to the total costs compared to direct costs.

Further, infected people younger than 60 years of age, those without a health insurance and those hospitalised experienced higher typical costs, the authors said and added that hospitalisation was the major driver of direct and indirect costs.

Seeking treatment in the private sector and hospitalisation also increase the risk of incurring catastrophic costs, the team said.

The costs were calculated using a tool developed by ‘Stop TB Partnership’, “a hosted entity of the United Nations Office for Project Services (UNOPS), with its Secretariat based in Geneva, Switzerland.”

The authors called for expanding the coverage of health insurance schemes to include people infected with tuberculosis, along with enabling an early notification of having the disease.
They also recommended sensitive strategies to address social determinants of tuberculosis, which may significantly reduce catastrophic costs incurred by the infected people