ECONOMIC BURDEN OF TUBERCULOSIS FOR PATIENTS AND HOUSEHOLDS IN SUB-SAHARAN AFRICA: A SYSTEMATIC REVIEW OF COST-OF-ILLNESS STUDIES
Author(s)
Kang Wang, BSC, MSc1, Lara Schramke, MSc2, Sweetness Laizer, BSc, MSc3, Julia Critchley, MPH, PhD4, reinout van crevel, PhD3, Musimenta Richard, MD5, Huajie Jin, BSc, MSc, PhD1.
1Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom, 2Protid Consortium, Nijmegen, Netherlands, 3Radboud University Medical Center (Radboudumc), Nijmegen, Netherlands, 4City St George’s, University of London, London, United Kingdom, 5Protid consortium, Kampala, Uganda.
1Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom, 2Protid Consortium, Nijmegen, Netherlands, 3Radboud University Medical Center (Radboudumc), Nijmegen, Netherlands, 4City St George’s, University of London, London, United Kingdom, 5Protid consortium, Kampala, Uganda.
OBJECTIVES: Tuberculosis (TB) caused an estimated 10.7 million cases and 1.23 million deaths globally in 2024. Africa accounted for 23% of global TB cases, with 16 of the 30 high TB burden countries located in Sub-Saharan Africa (SSA). Although TB diagnosis and treatment are free in many SSA countries, patients and households continue to face substantial non-medical and indirect costs. Evidence on the magnitude, composition and methodological quality of TB cost-of-illness estimates remains fragmented.
METHODS: A systematic review was conducted in accordance with PRISMA guidelines to identify studies reporting the economic burden of TB in SSA. Six electronic databases were searched on 19 June 2025. Data on study characteristics, patient demographics, cost components, and methodological quality were extracted and standardised to 2023 USD values. Study quality was assessed using the Larg and Moss cost-of-illness checklist.
RESULTS: Thirty-nine studies from 14 SSA countries were included, most of which were prospective and prevalence-based. Sample sizes ranged from 52 to 1,134 participants. Pre-diagnosis direct medical costs ranged from USD 5.52-563.40, non-medical costs from USD 0.76-290.11, and indirect costs from USD 2.08-848.55. Post-diagnosis direct medical costs ranged from USD 5.54-1,600.82, non-medical costs from USD 5.33-2,352.09, and indirect costs from USD 41.73-5,127.55. Among 22 studies reporting total societal costs across the full TB episode, 11 (50.0%) reported costs below 20% of GDP per capita, while five (22.7%) reported costs exceeding 50%, and two (9.1%) exceeding 100% of GDP per capita.
CONCLUSIONS: TB imposes a substantial economic burden on patients and households across SSA, despite free TB services. Wide variation in estimates reflects differences in costing methods, perspectives, disease phase and productivity-cost valuation. More standardised methods, including harmonised cost-calculation methodologies, transparent reporting standards and improved reporting of non-medical and indirect costs are needed to inform social protection policies and future economic evaluations in SSA.
METHODS: A systematic review was conducted in accordance with PRISMA guidelines to identify studies reporting the economic burden of TB in SSA. Six electronic databases were searched on 19 June 2025. Data on study characteristics, patient demographics, cost components, and methodological quality were extracted and standardised to 2023 USD values. Study quality was assessed using the Larg and Moss cost-of-illness checklist.
RESULTS: Thirty-nine studies from 14 SSA countries were included, most of which were prospective and prevalence-based. Sample sizes ranged from 52 to 1,134 participants. Pre-diagnosis direct medical costs ranged from USD 5.52-563.40, non-medical costs from USD 0.76-290.11, and indirect costs from USD 2.08-848.55. Post-diagnosis direct medical costs ranged from USD 5.54-1,600.82, non-medical costs from USD 5.33-2,352.09, and indirect costs from USD 41.73-5,127.55. Among 22 studies reporting total societal costs across the full TB episode, 11 (50.0%) reported costs below 20% of GDP per capita, while five (22.7%) reported costs exceeding 50%, and two (9.1%) exceeding 100% of GDP per capita.
CONCLUSIONS: TB imposes a substantial economic burden on patients and households across SSA, despite free TB services. Wide variation in estimates reflects differences in costing methods, perspectives, disease phase and productivity-cost valuation. More standardised methods, including harmonised cost-calculation methodologies, transparent reporting standards and improved reporting of non-medical and indirect costs are needed to inform social protection policies and future economic evaluations in SSA.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH171
Topic
Economic Evaluation, Epidemiology & Public Health, Study Approaches
Topic Subcategory
Public Health
Disease
Infectious Disease (non-vaccine), No Additional Disease & Conditions/Specialized Treatment Areas