In-hospital costs of tuberculous meningitis in adult patients admitted at the Philippine General Hospital

Tuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculosis, but its in-hospital economic burden is poorly characterized in the Philippines, and no Philippine Health Insurance Corporation (PhilHealth) case rate specific to TBM exists. This retrospective, single-center cost-of-illness study included adults with clinically diagnosed TBM admitted to the Philippine General Hospital, Manila, from 2022 to 2024. Costs were hospital-billed charges before charity discounts and professional fee waivers. A gamma generalized linear model with log link estimated crude and adjusted cost ratios for nine prespecified covariates. Financial burden was expressed as episode cost relative to the 2023 national mean annual family income (PHP 353,230.00), a population benchmark rather than household-level catastrophic health expenditure. Among 130 patients (mean age 40.4 ± 14.8 years, 59.2% male), 50 of 125 with a known outcome died (40.0%). Among 129 admissions with a numeric total billed cost, the mean was PHP 202,596.00 ± 294,957.00 (median PHP 114,743.00), or USD 3716.00 in 2024 values. Medications were the largest component (48.0%). In the adjusted model ( n = 119), cost was independently associated with surgery (ratio 2.504, 95% CI 1.791–3.503) and nosocomial infection (ratio 1.976, 95% CI 1.290–3.027). HIV-positive status showed a positive association (ratio 2.154, 95% CI 1.081–4.295) that was unstable across robust-variance estimators and is reported as hypothesis-generating. Mean episode cost represented 58.4% of mean annual family income, and 89.9%, 61.2%, and 37.2% of admissions exceeded 10%, 25%, and 40% of that benchmark, respectively. No PhilHealth schedule examined (2013–2025) contained a TBM-specific case rate. The nearest listed rate (bacterial and other meningitides, PHP 25,700.00 to 33,410.00) covered an estimated 12.7% to 16.5% of the mean billed cost, and 91.5% of admissions exceeded even the higher value. A single TBM admission represented a catastrophic financial exposure under a population-benchmark measure, and nominal PhilHealth reimbursement, benchmarked against the nearest available case rate, covered only a small fraction of billed charges. Surgery and nosocomial infection were independently associated with higher cost. These observational, single-center findings highlight the potential need for a dedicated TBM case rate and stronger financial risk protection.