Journal of Epidemiology and Global Health

Volume 11, Issue 1, March 2021, Pages 83 - 91

Estimating Catastrophic Costs due to Pulmonary Tuberculosis in Bangladesh

Anita Sharif Chowdhury1, Md Shakil Ahmed2, Sayem Ahmed3, 4, Fouzia Khanam1, Fariha Farjana5, Saifur Reza6, Shayla Islam6, Akramul Islam6, Jahangir A.M. Khan4, 7, Mahfuzar Rahman1, 8, *, ORCID
1BRAC Research and Evaluation Division, BRAC Centre, Dhaka, Bangladesh
2BRAC Institute of Governance and Development, BRAC University, Dhaka, Bangladesh
3icddr,b, Dhaka, Bangladesh
4Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
5Economics Discipline Khulna University, Khulna-9208, Bangladesh
6BRAC Tuberculosis Control Programme, BRAC Centre, Dhaka 1212, Bangladesh
7Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
8Centre for Injury Prevention, Health Development and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
*Corresponding author. Email:
Corresponding Author
Mahfuzar Rahman
Received 30 September 2019, Accepted 13 May 2020, Available Online 7 June 2020.
DOI to use a DOI?
Tuberculosis; catastrophic health expenditure; cost drivers; out-of-pocket payment; Bangladesh

To eliminate TB from the country by the year 2030, the Bangladesh National Tuberculosis (TB) Program is providing free treatment to the TB patients since 1993. However, the patients are still to make Out-of-their Pocket (OOP) payment, particularly before their enrollment Directly Observed Treatment Short-course (DOTS). This places a significant economic burden on poor-households. We, therefore, aimed to estimate the Catastrophic Health Expenditure (CHE) due to TB as well as understand associated difficulties faced by the families when a productive family member age (15–55) suffers from TB. The majority of the OOP expenditures occur before enrolling in. We conducted a cross-sectional study using multistage sampling in the areas of Bangladesh where Building Resources Across Communities (BRAC) provided TB treatment during June 2016. In total, 900 new TB patients, aged 15–55 years, were randomly selected from a list collected from BRAC program. CHE was defined as the OOP payments that exceeded 10% of total consumption expenditure of the family and 40% of total non-food expenditure/capacity-to-pay. Regular and Bayesian simulation techniques with 10,000 replications of re-sampling with replacement were used to examine robustness of the study findings. We also used linear regression and logit model to identify the drivers of OOP payments and CHE, respectively. The average total cost-of-illness per patient was 124 US$, of which 68% was indirect cost. The average CHE was 4.3% of the total consumption and 3.1% of non-food expenditure among the surveyed households. The poorest quintile of the households experienced higher CHE than their richest counterpart, 5% vs. 1%. Multiple regression model showed that the risk of CHE increased among male patients with smear-negative TB and delayed enrolling in the DOTS. Findings suggested that specific groups are more vulnerable to CHE who needs to be brought under innovative safety-net schemes.

© 2020 Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (

Download article (PDF)
View full text (HTML)

Journal of Epidemiology and Global Health
11 - 1
83 - 91
Publication Date
ISSN (Online)
ISSN (Print)
DOI to use a DOI?
© 2020 Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (

Cite this article

AU  - Anita Sharif Chowdhury
AU  - Md Shakil Ahmed
AU  - Sayem Ahmed
AU  - Fouzia Khanam
AU  - Fariha Farjana
AU  - Saifur Reza
AU  - Shayla Islam
AU  - Akramul Islam
AU  - Jahangir A.M. Khan
AU  - Mahfuzar Rahman
PY  - 2020
DA  - 2020/06/07
TI  - Estimating Catastrophic Costs due to Pulmonary Tuberculosis in Bangladesh
JO  - Journal of Epidemiology and Global Health
SP  - 83
EP  - 91
VL  - 11
IS  - 1
SN  - 2210-6014
UR  -
DO  -
ID  - Chowdhury2020
ER  -