A Systematic Review and Meta-Analysis on Catastrophic Cost Incurred by Tuberculosis Patients

Abstract Background: One of the World Health Organization End Tuberculosis (TB) Strategy is to reduce the proportion of TB affected families facing catastrophic costs (CC) to 0% by 2020. CC is defined if total cost related to TB management exceeded 20% of annual pre-TB household income. This study aimed to estimate the pooled proportion (PP) of TB affected households who suffered from CC. Method: A search of the online database through September 2020 was performed. Of 5114 articles, 29 articles were included in meta-analysis. We used R software to estimate the PP at 95% confidence intervals (CIs) using the fixed/random-effect models. Result: The PP of patients faced CC was 43%. Meta-regression revealed that country, drug sensitivity and HIV co-infection were the main predictors. CC incurred by drug sensitive, drug resistant and HIV coinfection patients were 32%, 80%, and 81% respectively. Lower CC incurred by active than passive case finding; 12% versus 42%. Direct cost represented 55% (95% CI 43-66) of the total cost. About 45% of TB-affected household faced catastrophic health expenditure at cut-off point of 10%. Conclusion: There is still a significant proportion of TB patients facing CC, which represent a main obstacle against TB control.PROSPERO registration: CRD42020221283