COST OF SEEKING TB TREATMENT AND ITS ASSOCIATED FACTORS AMONG PATIENTS ATTENDING TB CLINICS IN JIGJIGA TOWN, EASTERN ETHIOPIA

Abstract

Background: Tuberculosis (TB) is a leading cause of mortality and a major public health concern in Ethiopia. It primarily affects economically active individuals, resulting in severe socioeconomic consequences. Patients with tuberculosis face healthcare expenses that can hinder their access to and adherence to treatment. However, evidence regarding the economic cost of tuberculosis among patients in Eastern Ethiopia remains limited. Objective: To assess the cost of seeking tuberculosis (TB) treatment and its associated factors among patients attending TB clinics in Jigjiga Town, Eastern Ethiopia Methods: A health facility-based cross-sectional study was conducted among 303 randomly selected adults with TB in Jigjiga Town from September 1 to 30, 2024. Data were collected using structured, interviewer-administered questionnaires to assess all cost parameters. The data were entered into Epi-Data version 3.1 and analyzed using SPSS version 23, employing descriptive and inferential statistics to analyze the data. We fitted a generalized linear model (gamma family, log link) to identify the predictors of TB treatment costs. All associations were evaluated at the 5% significance level. Results: The patients’ costs ranged from ETB 280 to 10,330, with a median of ETB 1600 (IQR: 2500). Direct medical costs ranged from ETB 280 to 5300, with a median of ETB 1250 (IQR: 2121). Direct non-medical costs ranged from ETB 300 to 1950, with a median of ETB 500 (IQR: 500). Indirect costs ranged from ETB 300 to 6500, with a median of ETB 500 (IQR: 1500). The generalized linear model identified several significant predictors of treatment costs. Extrapulmonary TB increased costs by 63% (p = 0.03). Patients aged 40–60 incurred 38% higher costs than those aged 18–39 (p = 0.02), while households with 6–10 members faced 28% higher costs (p = 0.04). Higher education levels reduced costs substantially: primary education by 65% (p < 0.001), secondary education by 81% (p < 0.001), and college or above by 70% (p = 0.02). Treatment at health centers was associated with 82% higher costs (p = 0.02). Sex, residence, and marital status were not significantly associated with treatment costs. Conclusion: Despite Ethiopia’s policy of providing free TB treatment in public facilities, TB patients in Jigjiga Town face considerable economic burden from both direct and indirect costs, and these costs vary by demographic, clinical, and access-related factors. Patients incurred xi substantial direct medical expenses (consultation, investigations, drugs) and non-medical costs (transportation, food). The median direct medical cost was ETB 1,250, and the median non medical cost was ETB 500, despite Ethiopia’s policy of free TB treatment. Wage loss due to missed workdays contributed significantly to the overall burden, with a median indirect cost of ETB 500; higher costs were associated with extrapulmonary TB, age 40–60, larger households (6–10 members), and treatment at health centers, while higher education levels significantly reduced costs.