# Patient costs for drug-resistant TB diagnosis and pre-treatment evaluation in North India

## TL;DR

This study finds that despite free services, many drug-resistant TB patients in India face high costs, mainly due to lost income.

## Contribution

The study quantifies catastrophic costs for DR-TB patients in North India and identifies risk factors.

## Key findings

- Median total cost for DR-TB patients was USD326.6, with 48.2% spent on diagnosis.
- 32% of patients faced catastrophic costs, with manual labourers at higher risk.
- Indirect costs made up 66% of total expenses, highlighting the impact of lost income.

## Abstract

India's National TB Elimination Programme (NTEP) aims to eliminate TB-related catastrophic expenditure by offering free diagnosis and treatment. However, 3.9% of TB patients have drug-resistant TB (DR-TB) and are facing higher costs.

To assess DR-TB patients' diagnosis and pre-treatment evaluation costs, catastrophic cost incidence, and its relation to patient characteristics.

The study included DR-TB patients from three District Drug-Resistant TB Centres in Delhi and Faridabad (October 2021–June 2022). Socio-economic and clinical characteristics and direct medical and non-medical costs from drug susceptibility testing eligibility to the start of DR-TB treatment were collected using patient interviews and records. Indirect costs were calculated via the human capital approach, defining catastrophic costs as expenses over 20% of household annual income. Multivariable regression was used to estimate the effects of patient characteristics on catastrophic costs.

Of 158 patients, 37.3% were aged 19–30 years, and 55.7% were women. Median total cost was USD326.6 (IQR 132.7–666.7), with 48.2% for diagnosis and 66.0% indirect. 32% faced catastrophic costs, with manual labourers at higher risk (adjusted OR 4.4).

Despite free diagnosis and treatment, a significant portion of DR-TB households in India incur catastrophic costs, mainly from indirect expenses, indicating a need for targeted policy and programme interventions.