A Systematic Review and Meta-Analysis on Catastrophic Cost incurred by Tuberculosis Patients and their Households

Background As one of the World Health Organization (WHO) End Tuberculosis (TB) Strategy is to reduce the proportion of TB affected families that face catastrophic costs to 0% by 2020. This systematic review and meta-analysis aimed to estimate the pooled proportion of TB affected households who face catastrophic cost. Method A search of the online database through September 2020 was performed. A total of 5114 articles were found, of which 29 articles got included in quantitative synthesis. Catastrophic cost is defined if total cost related to TB exceeded 20% of annual pre-TB household income. R software was used to estimate the pooled proportion at 95% confidence intervals (CIs) using the fixed/random-effect models. Result The proportion of patients faced catastrophic cost was 43% (95% CI 34-52, I 2 = 99%); 32% (95% CI 29 – 35, I 2 = 70%) among drug sensitive, and 80% (95% CI 74-85, I 2 = 54%) among drug resistant, and 81% (95%CI 78-84%, I 2 = 0%) among HIV patients. Regarding active versus passive case finding the pooled proportion of catastrophic cost was 12% (95% CI 9-16, I 2 = 95%) versus 42% (95% CI 35-50, I 2 = 94%). The pooled proportion of direct cost to the total cost was 45% (95% CI 39-51, I 2 = 91%). The pooled proportion of patients facing catastrophic health expenditure (CHE) at cut of point of 10% of their yearly income was 45% (95% CI 35-56, I 2 = 93%) while at 40% of their capacity to pay was 63% (95% CI 40-80, I 2 = 96%). Conclusion Despite the ongoing efforts, there is a significant proportion of patients facing catastrophic cost, which represent a main obstacle against TB control. PROSPERO registration CRD42020221283