Determinants of Catastrophic Cost and Out-of-Pocket Expenditure Incurred by Tuberculosis Patients Under the National Tuberculosis Elimination Program in Lucknow District

BACKGROUND: End TB Strategy seeks to eliminate catastrophic costs for TB-affected households. OBJECTIVES: The study was done to address the knowledge gap with regards to catastrophic & out of pocket expenses (OOPE) incurred by TB patients and to identify its determinants. MATERIALS AND METHODS: A cross-sectional study was carried out at 2 randomly selected Tuberculosis Units in Lucknow district. Three hundred and seventy one drug sensitive TB patients were interviewed using a semi structured schedule to assess direct, indirect & coping cost and its determinants over the course of treatment. Chi square and Mann Whitney U test was applied to measure association of categorical and continuous data variable respectively, with incurring catastrophic cost. Multivariate regression analysis was used to identify predictors for catastrophic cost . RESULTS: About 18% of patients had catastrophic expenses, with a median of INR 28,670 (INR 6000-215,375) and a total median OOPE of INR 10,150 (INR 0-215,375). A higher proportion of households with TB patients aged 15-59 years, female, non-Hindu, rural inhabitants, and educational levels below high school experienced catastrophic and OOPE. Multivariate regression analysis revealed "Recurrent TB episodes," "place of first consultation," and "socioeconomic class-SEC" as significant predictors. TB patients with recurrent TB, First consultation at a private facility and belonging to lower SEC were more likely to incur catastrophic expenses. CONCLUSIONS: Strengthening early case detection and enrollment of TB patients under National TB Elimination Programme in vulnerable population and addressing determinants like recurrent TB through tailored IEC can cut down on catastrophic and OOPE.