OBJECTIVES: In Ghana, Direct cost of Multi-Drug Resistant (MDR) TB treatment is mainly covered by public sector through Global Fund financing mechanism. This includes economic support of patients to reduce out-of-pocket payment, improve treatment uptake and adherence. In spite of this, MDR-TB patients experience several economic barriers to access healthcare. This study evaluated the direct cost of illness to the patients and determine the adequacy of economic support to inform policy in the Greater Accra Region.

METHODS: We conducted a census of all MDR-TB patients diagnosed in Greater Region, Ghana from January 2013- December 2016. Reviewed MDR-TB laboratory and treatment registers and identified all MDR-TB client diagnosed during the period. All clients who were alive at time of study and had not been lost to follow up participated in the study. We interviewed participants using digitized structured questionnaire on TBcare mobile app. Data abstracted include demographic, occupation, monthly income, cost of transportation, feeding, consultation, diagnosis, hospitalization, food supplement, medication or treatment and accommodation (if client lost it due to illness). We also abstracted data of direct financial support received from Global fund through Health facility. Data was managed in EPI info 7 to determine per capita direct cost and estimated total direct cost saving to patients.

RESULTS: Cumulative incidence MDR-TB was 1.4/100,000 with 14.5 percent Case fatality and 16.4 percent lost to follow up. Age ranged 18-58 years with mean 38.6±10.2 and 77.8 percent males.

Monthly Income ranged 0.00-1162.80 USD with mean 168.10 USD Direct cost of illness ranged 300.50 – 16,130.20 USD with per capita direct cost of illness 2,202.60 USD which constitutes 109.2 percent of client’s annual income. Total Direct cost saving to patients 121,144.50 USD

CONCLUSIONS: In spite of Global fund economic support, direct cost of illness to MDR-TB patients in the region is still high, constituting 109% of annual income.