Out-of-pocket expenditure incurred by patients suffering from tuberculosis treated under national TB elimination program: A mixed method study from Papum-pare district of Arunachal Pradesh, India.

BACKGROUND: Out-of-Pocket Expenditure (OOPE) refers to the direct payments made by individuals for healthcare services and non-medical expenses, excluding health taxes or insurance premiums. Although the National Tuberculosis Elimination Program (NTEP) provides free laboratory services and medications, tuberculosis continues to impose a financial burden on underprivileged populations. This is due to increased healthcare costs, loss of daily wages, and dependency on others. Therefore, this study was conducted with the objectives to determine OOPE for smear-positive tuberculosis patients who are currently under treatment or diagnosed and enrolled within last 1 year under NTEP. 2. To assess the coverage and completeness of Direct Benefit Transfer (DBT).

METHODS: A mixed method study using a tool-based questionnaire was conducted amongst the patients registered under NTEP in Papum-pare district during a period of June 2022 till May 2023. Total of 320 patients were eligible for the study and were interviewed. The data was collected from the patient card and by using a Questionnaire from the WHO's "The Tool to estimate patients' costs". Mean and median costs were used for comparison.

RESULTS: The overall estimated mean total costs expended from the onset of symptoms and till treatment completion were Rs.41481.04 under NTEP. Among direct medical costs, investigation fee (Rs.14, 415.16) and direct non-medical costs, hospitalisation cost (Rs. 47,614.49) were maximum.29.95 % patients stopped working less than 1 month and had average per capita income Rs.6701.25. 28.44 % patients borrowed money to cover expenses and 0.31 % sold their land. 55.78 % patients enrolled under Nikshay Scheme received DBT.

CONCLUSION: Compliance to treatment was good and an overall cost incurred by TB patients was low. However, still there is a huge burden of expenses among lower economic section due to scarcity of medicine in DOTS centres and delayed transfer of DBT. The role of NIKSHAY SCHEME in such settings requires further study.