National Tuberculosis Patient Cost Survey in Nepal 2024

Overview

Tuberculosis remains the seventh leading cause of deaths in Nepal, posing a substantial public health and socioeconomic challenge. The Government of Nepal has adopted the End TB Strategy, which prioritizes reducing catastrophic costs for TB-affected households to zero. In line with this strategy, the survey thus aimed to assess the costs associated with TB diagnosis and treatment, determine the proportion of households facing catastrophic costs, and provide evidence-based recommendations to mitigate economic barriers. Additionally, the survey explored the prevalence of depression and stigma among people with TB.

The primary objectives of the study were:

• To determine the direct and indirect costs due to TB illness, diagnosis, and care.
• To estimate the proportion of TB-affected households experiencing catastrophic costs due to TB, including those affected by DS-TB and DR-TB.

Method

This was a nationally representative cross-sectional survey using a stratified cluster sampling approach. The survey interviewed 600 drug-susceptible TB (DS-TB) and 400 drug-resistant TB (DR-TB) patients across all seven provinces.

Key findings

• More than half (51%) of TB-affected households experienced catastrophic costs due to TB with DR-TB households disproportionately affected (75%) compared to DS-TB households (50%).
• Direct non-medical costs, including expenses for transportation and nutritional supplements, accounted for 44% of the total costs and emerged as the primary driver of catastrophic expenditures, followed by indirect costs (39%) and direct medical costs (17%).
• Nutritional supplements and extra food intake alone constituted 35% of the direct non-medical costs.
• Nearly one third (31%) of participants reported using coping mechanisms to address the financial strain caused by TB, and the overall poverty headcount among TB-affected households increased by 23%, with the poorest quintile experiencing the greatest impact (41% increase).
• Mental health and stigma were also notable concerns, with nearly 18% of people with TB experiencing moderate to severe depression and 60% reporting moderate levels of TB-related stigma.
• The median direct medical cost for all participants was Rs. 6,377 (95% CI: 5,000-14,857), with DR-TB patients incurring a median medical cost of Rs. 6,837 and Drug-Susceptible Tuberculosis (DS-TB) patients incurring Rs. 6,377.
• The median direct non-medical cost was Rs. 42,129 (95% CI: 38,955-45,304) for all participants. The median direct non-medical cost for people with DR-TB was Rs. 73,915 (95% CI: 44,857-1,22,157), which was significantly higher than the cost for people with DS-TB (Rs. 39,183 [95% CI: 32,600-47,954]).
• The median indirect cost for people with DRTB was approximately eight folds (Rs. 24,856 [95% CI: 4821-73987]) higher than DS-TB participants (Rs. 3,384 [95% CI: 486-33212]), which was also statistically significant.
• The largest cost driver was direct non-medical costs, accounting for 44% of total expenses among all participants, 54% among DRTB patients, and 43% among those with DS-TB.

Recommended readings

• National TB Preventive Treatment Protocol 2024
• National Guide for use of digital x-ray with AI in camp settings
• National Tuberculosis Programme Annual Report 2018
• National Tuberculosis Program Update in Nepal #WorldTBDay #EndTB
• National TB Prevalence Survey, 2018-19 Key findings
• World Tuberculosis Day 2020! It’s time to End TB!
• National Guideline on Drug Resistant TB Management 2019, Nepal
• National Tuberculosis Management Guideline 2019, Nepal
• Global Tuberculosis Report 2019: Latest status of the tuberculosis epidemic
• National TB Prevalence Survey, 2018-19 Key findings
• New WHO recommendations to prevent tuberculosis aim to save millions of lives
• World Health Organization (WHO) Information Note Tuberculosis and COVID-19
• World Tuberculosis Day 2020! It’s time to End TB!
• People-centred framework for tuberculosis programme planning and prioritization, User guide
• Global Tuberculosis Report 2019: Latest status of the tuberculosis epidemic
• Dissemination of Findings and Recommendations of Joint External Monitoring Mission(JEMM) of Nepal National Tuberculosis Program
• National Tuberculosis Programme Annual Report 2018
• National Strategic Plan for Tuberculosis Prevention, Care and Control 2016 – 2021
• NTP, Nepal: New TB Treatment Algorithm & Regimen (Updated)
• WHO announces landmark changes in MDR-TB treatment regimens
• TB Vaccine results announce a promising step towards ending the emergency
• 7 million people receive record levels of lifesaving TB treatment but 3 million still miss out

Related reports

• Global Tuberculosis Report 2024
• Global tuberculosis report 2023
• Global Tuberculosis Report 2022
• Global Tuberculosis Report 2021
• Global Tuberculosis Report 2020
• National Strategic Plan to End Tuberculosis in Nepal
• Global Tuberculosis Report 2019: Latest status of the tuberculosis epidemic
• Global Tuberculosis Report 2018
• WHO Global Tuberculosis report 2015
• Global tuberculosis report 2014: Improved data reveals higher global burden of tuberculosis