Tuberculosis (TB) continues to impose a heavy economic burden on patients in India, with nearly 45 per cent incurring catastrophic costs due to lost productivity and hospitalization despite free diagnosis and care under the Government’s National TB Elimination Programme (NTEP), a recent study by the Indian Council of Medical Research (ICMR) has revealed.

Many patients, particularly those from lower-income groups and without health insurance, face significant out-of-pocket expenses, it said, noting that notably, hospitalised patients with TB (PwTB) and those notified from the private sector were more likely to incur catastrophic costs.

The study led by researchers from the ICMR-National Institute of Epidemiology (ICMR-NIE), in Chennai and published in the Global Health Research and Policy journal, estimated the costs incurred by 1,407 persons with TB during their care and also identified the factors associated with the costs.

The team led by Kathiresan Jeyashree, a scientist at ICMR-NIE measured total patient costs through direct medical, non-medical, and indirect costs. Catastrophic costs were defined as expenditures on TB care cost more than 20 per cent of the annual household income.

The mean age of the 1407 PwTB interviewed was 40.8 (16.8) years. Among them, 865 (61.5 per cent) were male, and 786 (55.9 per cent) were economically active. Thirty-four (2.4 per cent) had Drug Resistant TB (DRTB), and 258 (18.3 per cent) had been hospitalized for TB.

Direct costs accounted for 34 per cent of the total costs. TB patients less than 60 years of age, without health insurance, and those hospitalised for the condition experienced higher median costs. About 45 per cent of TB patients experienced catastrophic costs.

The study called for enabling early notification of TB, and "expanding the coverage of health insurance schemes to include persons with TB.

"Implementing TB-sensitive strategies to address social determinants of TB may significantly reduce catastrophic costs incurred by persons with TB,” Jeyashree said.

Expanding the net of coverage of health insurance schemes, both public and private, to cover TB diagnosis, treatment and rehabilitation will encourage better health seeking and also reduce financial catastrophe in households of PwTB. “Future costing exercises may also calculate the costs incurred by patients after declaration of their treatment outcome, at least for a period of two years to capture costs due to physical, social and economic sequelae of TB,” suggested the researchers including those from the WHO besides ICMR.