Costs incurred by patients with pulmonary tuberculosis in rural India

Abstract

Setting: Vellore District, Tamil Nadu, India.

Objective: To measure patient costs associated with diagnosis and the complete treatment of tuberculosis (TB).

Design: Prospective structured interview of 100 new smear-positive adult patients being treated for TB in Tamil Nadu, India, selected evenly from 10 representative health facilities in the state. Direct (out-of-pocket) and indirect (lost-time) costs were quantified by period of illness using a standardised questionnaire, and univariate regression investigated predictors of total cost.

Results: Seventy-four per cent of patients were male, with a mean age of 40.2 years. All were given a first-line regimen, and none had been previously treated. The mean direct cost was US$34.91 (SD $46.94), the mean indirect cost was $526.87 (SD $375.71), and the total mean cost per patient was $562.66 (SD $287.48). Twenty-five patients were admitted to hospital, at a mean cost of $279.43 (SD $142.88) per admission. Variation in costs was associated with admission.

Conclusion: TB patients in India incur large costs associated with TB illness. The greatest single cost was time lost during admission. Total patient costs represent 193% of the estimated monthly income of a manual labourer.