Out-of-Pocket Expenditure and Catastrophic Cost Incurred by Tuberculosis Patients in Uttar Pradesh, India

Abstract Background: The National Tuberculosis Elimination Programme (NTEP) aims to eliminate catastrophic costs among people with tuberculosis (TB) and their households by 2025. This study assessed the economic burden of TB among people with TB in Uttar Pradesh, India, with particular focus on out-of-pocket (OOP) expenditure and catastrophic costs. Material and Methods: A cross-sectional survey was conducted among 209 people with TB from 10 districts of Uttar Pradesh using a structured questionnaire. Information related to household income, direct medical expenditure, indirect costs, and wage loss was collected. Expenditure data were summarized using median, interquartile range, mean, standard deviation, and proportions. Month-wise expenditure data were further analyzed using a Moving Average approach to estimate expenditure trends during the standard 6-month treatment period. Results: Approximately 19.5% of people with TB experienced catastrophic expenditure, with agricultural laborers (33%) and housewives (31%) disproportionately affected. The median catastrophic expenditure among affected households was Rs. 37,750/-. Indirect costs, particularly wage loss, contributed substantially to the overall financial burden. While nearly half of the participants reported no direct OOP expenditure, some households incurred very high treatment-related costs. The projected indirect expenditure per patient during the 6-month treatment period was approximately Rs. 5,000/-, of which wage loss accounted for nearly Rs. 4,000/-. Conclusions: Although direct treatment costs under NTEP were relatively low, indirect costs continued to impose substantial economic burden on affected households. Strengthening financial risk protection measures, wage compensation mechanisms, and patient-centered support strategies may help reduce catastrophic expenditure associated with TB care.