Alarming economic burden of TB treatment in four states of India: Study

A new study of 1,482 TB patients across four states – Assam, Maharashtra, Tamil Nadu, and West Bengal – has revealed shockingly high rates of catastrophic costs, with 30 per cent to 61 per cent experiencing financial hardship exceeding 20 per cent of pre-TB annual household income mainly due to delays in diagnosis and income loss because of unemployment during long TB treatment.

The researchers from the George Institute for Global Health in collaboration with researchers from Indira Gandhi Government Medical College (Nagpur), and the London School of Hygiene and Tropical Medicine (UK) have conducted a survey shedding light on the staggering financial burden faced by Tuberculosis (TB) patients in India.

The findings underscore the urgent need for both policy and public interventions to alleviate this burden on patients and the nation. The study was led by Dr. Susmita Chatterjee along with Palash Das, Gayatri Bhambure, Radha Munje, and Anna Vassall.

The study conducted against the backdrop of the World Health Organization’s End TB strategy, which serves as a blueprint for countries to achieve zero catastrophic costs for TB-affected households, reveals concerning statistics about the economic toll of the disease in India. With the nation bearing the highest TB burden globally, the reported incidence reached 2.42 million cases in 2022.

Speaking about the research, Dr. Susmita Chatterjee, The George Institute for Global Health India, said, “Following the largest cohort of drug-susceptible TB patients till date, our study concluded that a significant proportion of study participants faced catastrophic cost and the proportion was much higher when income loss because of TB treatment was considered in total cost calculation method. Therefore, ensuring uninterrupted livelihood during TB treatment is an absolute necessity.”

Of particular concern was the fact that for over half of the participants who faced catastrophic cost, costs became catastrophic even before commencing TB treatment due to delays in diagnosis. The average delay of 7-9 weeks from symptom onset to treatment initiation, twice the accepted delay period, resulted in substantial financial burdens from repeated consultations, tests, and travel expenses.

The study’s implications are profound, calling for immediate action at both policy and community levels. Supply-side interventions such as intensifying private sector engagement and rapid diagnosis are crucial, alongside demand-side initiatives like community awareness campaigns. Addressing the delay in diagnosis through early case detection and active community engagement is paramount to reducing economic burdens.

The findings of this study serve as a clarion call for concerted efforts from policymakers, healthcare providers, and communities to alleviate the economic burden of TB treatment in India. By implementing comprehensive strategies, we can not only reduce financial hardships on patients but also move closer to achieving the ambitious targets set forth by the End TB strategy.