Direct costs of pulmonary tuberculosis among patients receiving treatment in Bauchi State, Nigeria

BACKGROUND: To access tuberculosis (TB) services, patients have to bear the costs of out-of-pocket expenditures or direct costs for transport, drugs and other services that are not provided free-of-charge. These costs could represent a barrier to care, especially in a country such as Nigeria, where per capita gross national income is only US$1160 and 46% of the urban population live below the poverty line. OBJECTIVE: To describe the direct costs of TB diagnosis and treatment in Bauchi State, Nigeria, from the patient's perspective. METHODS: A cross-sectional study. A sample size of 255 patients was randomly selected from 27 of 67 facilities in Bauchi State, Nigeria. RESULTS: The median out-of-pocket cost for hospitalised patients was estimated at US$166.11, while ambulatory patients paid an estimated median cost of US$94.16, equivalent to about 9-38% of their average annual income. Female patients spent a higher proportion of their income on diagnosis and treatment than males (P < 0.0001). The median out-of-pocket costs borne by patients before, during and after diagnosis were estimated at respectively US$35.23, US$27.12 and US$23.43 for ambulatory patients, and additional average out-of-pocket spending of US$66.44 for patients hospitalised during their illness. Pre-diagnosis, diagnosis and post-diagnosis out-of-pocket spending did not vary significantly by human immunodeficiency virus status (P > 0.05) and sex (P > 0.05). CONCLUSION: The costs of anti-tuberculosis treatment found in this study are expensive and potentially catastrophic for many patients and their families.