Measuring the catastrophic cost of diagnosis, treatment, care, and support on people and families affected by tuberculosis in Iran and Afghanistan

• Tuberculosis (TB)-related catastrophic costs in Iran and Afghanistan are 20% and 49%, respectively. • The likelihood of facing catastrophic costs was higher in households with multidrug-resistant patients. • Both countries are far from achieving a goal of the End TB Strategy, which was to eliminate the catastrophic costs of TB. Abstract A key goal of the World Health Organization's End Tuberculosis (TB) Plan was to eliminate TB-related catastrophic costs by 2030. This study aimed to measure the achievement of two countries (Iran and Afghanistan) in this plan. Using a random cluster sampling, 649 patients with TB were interviewed in 2020. This study calculated the direct, indirect, and catastrophic costs for Iran and Afghanistan and applied regression estimators and a sensitivity analysis. The results showed that 49% of households in Afghanistan and 20% of households in Iran faced TB-related catastrophic costs. Being in multidrug-resistant treatment (odds ratio [OR] = 3.670) was related to facing catastrophic costs. Households with a female (OR = 0.532), being an Iran resident (OR = 0.429), and being a university degree–holder (OR = 0.284) patient with TB had a lower likelihood of facing catastrophic costs. The findings of this study showed that these two countries are far from the goals of the World Health Organization for having zero TB-related catastrophic costs.