Financial Burden of Drug-sensitive Tuberculosis in India: A Systematic Review and Meta-analysis

Abstract Introduction: Tuberculosis (TB) poses a significant public health and economic burden in India, with out-of-pocket expenditure (OOPE) often leading to financial distress. This study reviews and meta-analyses costs associated with drug-sensitive TB care in India. Methods: Relevant studies from PubMed, Scopus, OpenAlex, CrossRef and Semantic Scholar were analysed. A random-effects meta-analysis estimated mean costs, including direct medical, direct non-medical, indirect medical, diagnostic and treatment expenses. Results: Analysing 18 studies, the overall mean cost per TB patient was ₹18,961 (95% confidence interval: ₹12,093–₹25,829), with direct medical costs at ₹7305, direct non-medical costs at ₹2346, indirect medical costs at ₹10,602, diagnostic costs at ₹10,028 and treatment costs at ₹12,999. Conclusion: TB care imposes a heavy financial burden on Indian households. Reducing OOPE through targeted interventions, strengthened social protection and expanded free services is essential to alleviate this hardship.