OBJECTIVES:

To estimate the baseline to measure one of the three indicators of the World Health Organization (WHO) End TB strategy (2015-2035), measure the costs incurred by patients affected by tuberculosis during a treatment episode and estimate the proportion of households facing catastrophic costs (CC) (defined as costs above 20% annual household income) and associated risk factors, in Colombia in 2021.

METHODS:

National cross-sectional survey with a probabilistic quantitative approach, designed according to the WHO methodology but with telephone interviews in adaptation to an exceptional pandemic data collection setting, collected costs per household for an episode of tuberculosis (medical and non-medical out-of-pocket expenses and indirect costs), loss of time, coping measures, self-reported income, and asset ownership. Total costs were expressed as a proportion of annual household income. A regression model estimated risk factors associated with CC.

RESULTS:

A total of 1,065 TB patients were interviewed, 65,7% men, 61,6% >35 years old, 82,2% with pulmonary TB, and 11,3% with HIV. In Colombia, the proportion of TB-affected households incurring in costs above 20% annual household income (CC) was 51.7% (95%CI: 45.4–58.0) overall, 51.3% (95%CI: 44.9–57.7) among patients with drug-sensitive TB, 65.0%% (95%CI: 48.0–82.0) among drug-resistant. The average patient cost of a TB case in Colombia was estimated at $1,218 (95% CI 1,106-1,330) including $860.9 (95% CI 776.1-945.7) for non-medical costs, $339 (95% CI 257 - 421) for the indirect costs, and $18.1 (95% CI 11.9 – 24.4) for the medical costs. The factors that influenced the probability of facing CC were income quintile, job loss, TB type and HIV status.

CONCLUSIONS:

Main cost drivers for CC were non-medical out-of-pocket expenses and loss of productivity (indirect costs). Current social protection programs ought to be expanded to mitigate the proportion of TB-affected households facing CC in Colombia, especially those with lower income levels.