Catastrophic costs among drug-susceptible tuberculosis households in the Guangxi Zhuang Autonomous Region, China: determinants and economic impact evaluation.

BACKGROUND

Tuberculosis (TB) remains a major poverty-associated infectious disease worldwide. This study is the first to quantify the incidence and determinants of catastrophic costs among drug-susceptible TB patients in Guangxi, providing critical evidence for developing poverty alleviation policies and promoting equitable TB care access.

METHODS

The study included 250 drug-susceptible TB patients who were registered and completed treatment between June 2023 and June 2024 in local designated TB hospitals across three counties in Guangxi with different per capita disposable income. Using structured questionnaires, we collected comprehensive data on socioeconomic characteristics and TB-related direct/indirect costs. All statistical analyses were performed using SPSS 27.0.

RESULTS

During the pre-diagnosis stage, post-diagnosis stage, and the entire course of TB care, the median out-of-pocket payments per TB patient were 2501.5 RMB, 2323.8 RMB, and 6323.7 RMB, respectively. Direct medical costs constituted the largest proportion of total costs at each stage of TB care. The incidence of catastrophic costs due to TB was 45.6% (114/250). The results of the x 2 test showed that there were statistically significant differences in the incidence of catastrophic costs according to education levels, annual household income, medical insurance type, and number of hospitalization days after diagnosis (p < 0.05). The results of the binary logistic regression analysis showed that patients with annual household income ≦20,000 RMB and those with more than 7 hospitalization days after diagnosis had a higher risk of catastrophic costs due to TB, and the ORs (95%CI) were 34.168 (12.742-91.625) and 7.488 (2.474-22.664), respectively.

CONCLUSION

Most costs were incurred before diagnosis and were primarily direct medical costs. To reduce catastrophic costs, we recommend targeted TB health education, enhanced screening/treatment monitoring, improved multi-tiered insurance coverage, support for rural low-income populations, early cost-warning systems, and sustainable TB-related poverty prevention mechanisms.