Tuberculosis is a major public health concern in Bangladesh. The National TB Control Programme (NTP) of Bangladesh had been offering free treatment to TB patients but the package does not cover all costs especially indirect expenses. These expenses turn out to be catastrophic for the socially and economically marginalised population, who are affected by TB more. Catastrophic Health Expenditure (CHE) reflects the economic burden and barriers which negatively influence accessing TB care for individuals suffering from it. Therefore, ensuring equity and universal healthcare for TB patients as well as eradicating the CHE of TB patients have long been identified as crucial agenda for health policymakers. Bangladesh has very little or no data available regarding the incidence of the catastrophic cost of TB. Under this backdrop, the current study was initiated to explore the catastrophic cost of TB in Bangladesh in order to determine effective programme strategies for health system delivery to control and eradicate TB.
The study found delay in care seeking after experiencing symptoms by the TB patients. One quarter (25.2%) of the patients were found to suffer from TB for two months or longer before enrolling in DOTS. Total cost per patients was BDT 10,360.5 where the largest share of cost (67%) was due to income loss (indirect cost) of the patients and their care-givers, followed by diagnostic test (12.1%) and medicine (12.3%). It was found that, cost of illness for TB was highest among the people with higher education, in higher wealth quintiles, among men and among the working age group of 25-45 years than older. Housewives, students, and agri-labour experienced the much lower cost of TB compared to service holders, small traders, unemployed and other categories of labours. The study found the incidence of TB catastrophic cost was 3% which was low compared to the other similar countries. The poorest households experienced catastrophic cost more than their richest counterpart, 5% versus 1%. The study also observed the incidence of catastrophic cost to be higher before commencing DOTS (3.5%) than during DOTS (2 %) treatment period. Males, people aged 25-35 years, divorced or widowed, people with no education, unemployed people and smear-negative patients have a higher chance of experiencing catastrophic cost. The regression model also showed that the probability of patients experiencing catastrophic cost was 16 times higher in inpatient than outpatient care.