Costs incurred by patients with pulmonary tuberculosis in rural India.

SETTING Vellore District, Tamil Nadu, India. OBJECTIVE To measure patient costs associated with diagnosis and the complete treatment of tuberculosis (TB). DESIGN Prospective structured interview of 100 new smear-positive adult patients being treated for TB in Tamil Nadu, India, selected evenly from 10 representative health facilities in the state. Direct (out-of-pocket) and indirect (lost-time) costs were quantified by period of illness using a standardised questionnaire, and univariate regression investigated predictors of total cost. RESULTS Seventy-four per cent of patients were male, with a mean age of 40.2 years. All were given a first-line regimen, and none had been previously treated. The mean direct cost was US$34.91 (SD $46.94), the mean indirect cost was $526.87 (SD $375.71), and the total mean cost per patient was $562.66 (SD $287.48). Twenty-five patients were admitted to hospital, at a mean cost of $279.43 (SD $142.88) per admission. Variation in costs was associated with admission. CONCLUSION TB patients in India incur large costs associated with TB illness. The greatest single cost was time lost during admission. Total patient costs represent 193% of the estimated monthly income of a manual labourer.