Household costs and health-related quality of life of childhood MDR-TB in Western Cape, South Africa
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Multidrug-resistant (MDR) tuberculosis (TB) in children remains a major public health challenge. Although treatment is free of direct charge in many countries, it can impose substantial indirect and non-medical costs on affected households. Evidence on the economic burden of childhood MDR-TB on families remains limited.
Methods
A cross-sectional household survey was conducted in the Western Cape, South Africa, among 45 households with a child <15 years who initiated MDR-TB treatment between 2018 and 2021. Socioeconomic status, costs of accessing care, and health-related quality of life (HRQoL) were assessed and linked to health service utilisation data to estimate household-level costs.
Results
The median total cost per household was ZAR 7,443 (US$504) per episode of care (IQR: ZAR 4,119–13,207), with indirect costs accounting for the largest share of household costs. Twenty-three (51.1%) of households incurred catastrophic health expenditure, defined as >20% of annual household income. Costs increased with hospital-based care, longer treatment duration, and more frequent caregiver visits. The HRQoL of children was generally high, though not uniformly distributed.
Conclusions
Childhood MDR-TB places substantial financial burden on already vulnerable households. Economic evaluations and care models should incorporate household costs and consider strategies to reduce the indirect burden of treatment on families.
Multidrug-resistant (MDR) tuberculosis (TB) in children remains a major public health challenge. Although treatment is free of direct charge in many countries, it can impose substantial indirect and non-medical costs on affected households. Evidence on the economic burden of childhood MDR-TB on families remains limited.
Methods
A cross-sectional household survey was conducted in the Western Cape, South Africa, among 45 households with a child <15 years who initiated MDR-TB treatment between 2018 and 2021. Socioeconomic status, costs of accessing care, and health-related quality of life (HRQoL) were assessed and linked to health service utilisation data to estimate household-level costs.
Results
The median total cost per household was ZAR 7,443 (US$504) per episode of care (IQR: ZAR 4,119–13,207), with indirect costs accounting for the largest share of household costs. Twenty-three (51.1%) of households incurred catastrophic health expenditure, defined as >20% of annual household income. Costs increased with hospital-based care, longer treatment duration, and more frequent caregiver visits. The HRQoL of children was generally high, though not uniformly distributed.
Conclusions
Childhood MDR-TB places substantial financial burden on already vulnerable households. Economic evaluations and care models should incorporate household costs and consider strategies to reduce the indirect burden of treatment on families.
Date Issued
2026-07-01
Date Acceptance
2026-03-27
Citation
IJTLD Open, 2026, 3 (7), pp.435-443
ISSN
3005-7590
Publisher
International Union Against Tuberculosis and Lung Disease (The Union)
Start Page
435
End Page
443
Journal / Book Title
IJTLD Open
Volume
3
Issue
7
Copyright Statement
© 2026 The Authors This is an open access article published by The Union under the terms of the Creative Commons Attribution License CC-BY.en access.
License URL
Identifier
10.5588/ijtldopen.25.0616
Publication Status
Published
Date Publish Online
2026-07-01