Study finds alarming financial hardship resulting from TB marring treatment programme

Delays in diagnosis, and loss of income due to unemployment over the long course of TB treatment, continues to mar the TB treatment programme in India, according to a survey result released on June 11. The survey of 1,482 TB patients across four States revealed alarming financial hardship resulting from disease.

A collaborative survey conducted by the George Institute for Global Health, New Delhi, along with the Indira Gandhi Government Medical College (Nagpur), and the London School of Hygiene and Tropical Medicine, U.K., highlighted the severe financial strain faced by TB patients in India.

The survey has recommended intensifying private sector engagement, improving rapid diagnosis, implementing community awareness campaigns, expanding health insurance coverage for pre-treatment expenses, and safeguarding TB patients from loss of income. According to a release issued by the institute, their findings underscore the urgent need for both policy and public interventions to alleviate the burden of TB on patients and the nation.

76% of TB patients received payment for nutritional support

“The study conducted against the backdrop of the World Health Organization’s (WHO) End TB strategy, which serves as a blueprint for countries to achieve zero catastrophic costs for TB-affected households, reveals concerning statistics about the economic toll of the disease in India. With the nation bearing the highest TB burden globally, the reported incidence reached 2.42 million cases in 2022,’’ noted the release.

The George Institute researchers followed a cohort of over a thousand drug-susceptible TB patients across four States in India — Assam, Maharashtra, Tamil Nadu, and West Bengal. Employing the WHO’s guidelines, the study calculated treatment costs, incorporating both direct (that is, actual money spent) and indirect costs, including time, productivity, and income loss.

“Following the largest cohort of drug-susceptible TB patients till date, our study concluded that a significant proportion of study participants faced catastrophic cost, and the proportion was much higher when income loss because of TB treatment was considered in the total cost calculation method. Therefore, ensuring uninterrupted livelihood during TB treatment is an absolute necessity,” Susmita Chatterjee of the George Institute for Global Health India said, speaking about the research.

“Our study showed significant delay from symptom onset to diagnosis, and our study participants spent more than half of total treatment cost even before starting the treatment. Further, during this period, they also propagated the disease. Therefore, reducing the pre-diagnosis delay should be the policy priority,” Dr. Chatterjee added.

The release said that, depending on the method of indirect cost calculation, between 30% to 61% of study participants faced catastrophic costs. Defined as out-of-pocket expenses exceeding 20% of pre-TB annual household income, catastrophic costs pose a significant threat to the financial stability of millions of TB-affected households in the country.

Of particular concern is the fact that for over half the participants who faced catastrophic cost, the costs became catastrophic even before commencing TB treatment due to delays in diagnosis. The average delay of seven to nine weeks from the onset of symptoms to the initiation of treatment, twice the accepted delay period, resulted in substantial financial burdens from repeated consultations, tests, and travel expenses.