Estimating the pre- and post-diagnosis costs of tuberculosis care for adults in Karachi, Pakistan: Household economic impact and strategies for meeting the costs

Abstract Background Despite of free TB care in Pakistan, patients still have to bear high costs which push them more into poverty. This study estimated the types of costs households bear for TB care, and coping mechanisms used for bearing TB expenditures among adults ≥ 18 years in Karachi, Pakistan. Methods A total of 516 TB patients with completion of at least one month intensive treatment were recruited from four public sector hospitals in Karachi, Pakistan. A standardized questionnaire to estimate patient's costs was administered. Direct medical and non-medical costs incurred as out-of-pocket and indirect costs (loss of income) during pre-diagnostic, diagnostic, treatment and hospitalization phase were estimated. Results Out of 516 participants, 52.1% were female with a mean age of 32.4 (± 13.7) years. The median costs per patient borne during the pre-diagnostic, diagnostic, treatment and hospitalization was estimated at USD63.8/ PKR7377, USD24/ PKR2755, USD10.5/ PKR1217 and USD349.0/ PKR40300, respectively. The total household median costs was estimated at USD129.2/ PKR14919 per patient. The median indirect costs were estimated at USD52.0/ PKR5950 per patient. First point of care was a private provider by 54.1% of patients, 36% attended public service, 5% and 4.1% went to dispensary and pharmacy, respectively. Conclusion TB patients bear substantial out-of-pocket costs before they are enrolled in publically funded TB program. There should be provision of transport and food vouchers, also health insurance for in-patient treatment. This advocates a critical investigation into an existing financial support network for TB patients in Pakistan with an eye towards easing the burden.