Indirect Cost of Treatment of Tuberculosis: Could It be A Major Cause for Treatment Failure Leading to Emergence of Drug Resistant Tuberculosis?

Introduction: Tuberculosis (TB) patients often incur huge costs due to TB care and the cost is even higher when it’s an MDR-TB treatment. Despite free TB treatment under the Revised National Tuberculosis Control Program (RNTCP), the indirect cost borne by the patients due to the diagnosis and treatment of TB puts a major economic burden on the patients. This expenditure may affect treatment adherence and might lead to poor outcomes.Method: A cross-sectional study was conducted in a government health facility in Karimganj, Assam with 165 patients from the facility who were at least one month into the treatment. A pre-tested interviewer administered questionnaire on sociodemographic, clinical characteristics, and total cost due to TB care was recorded during the interview.Result: Out of 165 study participants, 52.7% belonged to the most productive age group of 19-54 years and 64.2% were male. The median indirect cost was INR 2333.33, which was higher than the direct cost and it contributes 96% of the total median cost. The indirect cost was significantly higher in patients who visited private facility first and patients having hypertension and diabetes. The indirect cost of treatment is significantly higher in MDR-TB patients when compared to non-MDR-TB patients.Conclusion: Even after the provision of free diagnosis and treatment under RNTCP, the indirect cost puts a major financial burden on the patients and their household, however, when it comes to MDR-TB patients, the burden is even bigger.