The economic burden of tuberculosis care for patients and households in Africa: a systematic review

Int J Tuberc Lung Dis. 2012 Jun;16(6):733-9. doi: 10.5588/ijtld.11.0193. Epub 2012 Mar 8.


Objectives: To summarise the state of knowledge on the economic impact and consequences of tuberculosis (TB) diagnosis and treatment for patients/households in Africa, and to highlight any weaknesses in the work conducted to date.

Methods: We systematically searched for published articles in English between 1990 and June 2010 in eight databases and the World Health Organization (WHO) website. Broad search terms were used ('tuberculosis' OR 'tuberculosis/HIV' AND 'costs' AND 'Africa'). Only studies that reported any costs of TB care for patients/households were retained. All costs were converted to 2009 USD in accordance with WHO cost analysis guidelines.

Results: Overall, 11 articles from eight countries met the inclusion criteria. Only one study met all the quality criteria for a cost-of-illness study; most of the studies focused on urban populations, reported incomplete (pre-diagnostic/average) costs, and did not report coping costs. Mean patient pre-diagnostic costs varied between US$36 and US$196, corresponding to respectively 10.4% and 35% of their annual income. Average patient treatment costs ranged between US$3 and US$662, corresponding to 0.2-30% of their annual income. Pre-diagnostic household costs accounted for 13% and 18.8% of patients' annual household income, while total household treatment costs ranged between US$26 and US$662, accounting for 2.9-9.3% of annual household income; 18-61% of patients received financial assistance from outside their household to cope with the cost of TB care.

Conclusion: The average patient's/household's pre-diagnostic costs for TB care were catastrophic. More properly designed studies are needed among different populations throughout Africa.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adaptation, Psychological
  • Africa / epidemiology
  • Coinfection / economics
  • Coinfection / therapy
  • Cost of Illness
  • Developing Countries / economics*
  • Family Characteristics*
  • Financing, Personal*
  • HIV Infections / economics
  • HIV Infections / therapy
  • Health Care Costs*
  • Health Services Accessibility / economics*
  • Humans
  • Income*
  • Models, Economic
  • Tuberculosis / diagnosis
  • Tuberculosis / economics*
  • Tuberculosis / epidemiology
  • Tuberculosis / psychology
  • Tuberculosis / therapy*