Tuberculosis (TB) remains a significant public health challenge, despite free diagnosis and treatment under India’s National TB Elimination Program (NTEP). A recent study published in Global Health Research and Policy highlights that nearly half of people with TB (PwTB) in India incur “catastrophic costs,” primarily due to lost wages and hospital expenses, even though the treatment is free.

Understanding the Costs of TB Treatment

While NTEP aims to achieve a TB-free India by 2025 and aligns with the World Health Organization’s (WHO) ‘End TB Strategy’, which targets 2035, financial hardships remain a barrier. The study estimates that TB treatment and care costs an individual approximately USD 386 (around ₹32,000), with expenses falling into two categories:

1. Direct Costs (34% of Total Costs):
   • These costs, about USD 78, are primarily incurred before diagnosis or during hospitalization.
2. Indirect Costs (66% of Total Costs):
   • A significant USD 280 comes from lost wages or productivity, making this the larger burden for patients.

Who Faces the Greatest Burden?

The study, conducted by researchers from the TB Support Network, WHO Country Office for India, and ICMR-National Institute of Epidemiology, revealed that:

• Patients without health insurance face higher costs.
• Hospitalization significantly increases both direct and indirect expenses.
• Younger individuals (below 60 years) are particularly affected due to the loss of wages and productivity.
• Those seeking treatment in the private sector are at a higher risk of catastrophic costs.
• People from poorer economic backgrounds are disproportionately impacted.

Key Drivers of Catastrophic Costs

1. Hospitalization:
   • Accounts for most direct and indirect expenses, as patients incur high out-of-pocket costs.
2. Loss of Productivity:
   • TB patients often face extended periods of illness, leading to significant income loss.
3. Private Sector Treatment:
   • While NTEP offers free treatment, many patients still opt for private care, increasing financial risks.

Recommendations to Reduce the Financial Burden

The study emphasizes the need for systemic changes to ensure that TB patients do not face catastrophic costs. Key recommendations include:

1. Expanding Health Insurance Coverage:
   • Include TB patients under existing schemes to cover both direct and indirect costs.
2. Early Notification of TB Cases:
   • Prompt diagnosis and treatment can prevent hospitalization and reduce associated costs.
3. Addressing Social Determinants of TB:
   • Implement strategies to improve living conditions, nutrition, and access to healthcare, which are critical in reducing TB-related expenses.
4. Strengthening Public Sector Support:
   • Encourage more patients to utilize government healthcare facilities under NTEP.
5. Improved Private Sector Collaboration:
   • Regulate costs and ensure that private healthcare providers align with NTEP guidelines to reduce financial strain on patients.

Conclusion

While the National TB Elimination Program has made significant progress in offering free treatment, the financial burden of tuberculosis goes beyond medical bills. Addressing indirect costs such as lost wages and improving access to health insurance are crucial steps in reducing the hardships faced by TB patients.

Doctors, policymakers, and healthcare providers must work together to implement sensitive strategies that address the social and economic determinants of TB. By doing so, we can move closer to achieving a TB-free India while ensuring that patients are not financially devastated by the disease.

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