The catastrophic financial burden of extrapulmonary tuberculosis and asset index-based inequality analysis: A prospective cohort study analysing patients’ impoverishment

This prospective cohort study assessed the financial burden of extrapulmonary tuberculosis (EPTB) in India, revealing substantial costs across disease manifestations. Among 200 confirmed EPTB patients, those with pleuritis, meningitis, and other severe forms, incurred significantly higher out-of-pocket (OOP) and indirect costs than lymphadenitis patients. Over 90% of meningitis and 80% of pleuritis patients experienced catastrophic health expenditures (CHE), defined as costs exceeding 20% of annual income. Up to 42% of patients were pushed below the poverty line. Asset-based inequality analysis showed that lower socioeconomic groups faced a disproportionate cost burden. The cost of diagnostic tests and the less severe nature of EPTB lymphadenitis may delay seeking care until patients' ability to work is affected. Factors such as low income, comorbidities, diagnostic delays, and reduced working capacity were associated with CHE. Notably, presumptive non-TB patients also incurred significant OOP and productivity losses during their diagnostic journeys, despite ultimately receiving non-TB diagnoses. These findings highlight the need for universal health coverage and enhanced financial protection strategies to mitigate the economic impact of EPTB and similar chronic conditions.