Costs of tuberculosis for households and health care providers in Dar es Salaam, Tanzania

OBJECTIVE: To assess the costs of tuberculosis at household level in Dar es Salaam and to compare them with the provider costs of the national tuberculosis control programme. DESIGN: Tuberculosis patients were found by active case searching within a routine census in three areas of Dar es Salaam, and by examining records for residents already receiving treatment. Costs at household level were evaluated through a cross-sectional household survey. RESULTS: One hundred and ninety-one tuberculosis cases were included in the survey. With treatment periods of 8 to 12 months, extrapolated average costs of a period of illness to patients and their families were as follows: US 2 dollars for examination and laboratory costs, between US 17 dollars and US 50 dollars for consultation and drugs, less than US 1 dollar for hospitalization and between US 13 dollars and US 20 dollars for transport. The analysis revealed high costs due to inability to work, ranging from US 154 dollars to US 1384 dollars. These data were compared with the operation costs of the tuberculosis programme and proved to comprise 68% to 94% of total costs. CONCLUSIONS: For patients and their families, tuberculosis implies three main types of cost: drugs, transportation and, most importantly, financial loss due to inability to work. They represent around two thirds of total cost and are a high economic burden for households, in particular those with a low-income. While assessing tuberculosis control strategies such as direct case finding at home, it is therefore important to also include costs incurred at household level.