Direct patient costs associated with tuberculosis diagnosis in Yemen and Nepal

BACKGROUND: The diagnosis of TB requires multiple visits. Reducing the number of visits for diagnosis could make the process more accessible, with significant savings to the patients.OBJECTIVE: To describe direct costs incurred by patients consulting TB diagnostic centres.METHOD: Adults with cough >3 weeks' duration were interviewed using structured questionnaires in Yemen and Nepal to quantify their expenses.RESULTS: A total of 456 adults were interviewed. Most patients were accompanied, and 20% were smear-positive. Patients in Nepal were more likely to be male, to live in urban areas and were older (123/206 [60%], 152 [74%] and mean age 41 years) than in Yemen (120/250 [48%], 114 [36%] and mean age 35 years). Although most patients from rural areas stayed with relatives, their overall expenses were higher than for patients from urban areas. Clinic fees represented the highest expenditure in both countries, and rural patients paid more than urban patients in both settings. The expenses for diagnosis were equivalent to 1 week of the national income per capita.CONCLUSION: Patients incur considerable costs for diagnosis, and clinic fees represent a substantial component of these costs. Patients requiring investigations for TB should be able to access diagnostic services free of charge.