Tuberculosis (TB) remains a major public health challenge, not only because of its health burden but also due to the significant financial hardships it imposes on patients and their families. This systematic review, conducted by Olivia Alise D’Silva and colleagues, examines the catastrophic costs incurred by individuals undergoing TB care across low-, middle-, and high-income settings. Drawing from 76 studies, it provides the most comprehensive overview to date of the financial barriers faced by TB patients throughout the care continuum. Despite free or subsidised treatment being available in many countries, patients still shoulder substantial costs, primarily driven by hospitalisation, loss of income, and non-TB medications.
Costs are notably higher among those with drug-resistant TB and individuals identified through passive case finding. The findings underscore the urgent need for active case finding, improved drug-resistance testing, and the adoption of social protection measures to alleviate the financial burden and advance TB care equity globally.