Catastrophic costs among drug-susceptible tuberculosis households in the Guangxi Zhuang Autonomous Region, China: determinants and economic impact evaluation.

Background: Tuberculosis (TB) remains a major poverty-associated infectious disease worldwide. This study is the first to quantify the incidence and determinants of catastrophic costs among drug-susceptible TB patients in Guangxi, providing critical evidence for developing poverty alleviation policies and promoting equitable TB care access. Methods: The study included 250 drug-susceptible TB patients who were registered and completed treatment between June 2023 and June 2024 in local designated TB hospitals across three counties in Guangxi with different per capita disposable income. Using structured questionnaires, we collected comprehensive data on socioeconomic characteristics and TB-related direct/indirect costs. All statistical analyses were performed using SPSS 27.0. Results: During the pre-diagnosis stage, post-diagnosis stage, and the entire course of TB care, the median out-of-pocket payments per TB patient were 2501.5 RMB, 2323.8 RMB, and 6323.7 RMB, respectively. Direct medical costs constituted the largest proportion of total costs at each stage of TB care. The incidence of catastrophic costs due to TB was 45.6% (114/250). The results of the Conclusion: Most costs were incurred before diagnosis and were primarily direct medical costs. To reduce catastrophic costs, we recommend targeted TB health education, enhanced screening/treatment monitoring, improved multi-tiered insurance coverage, support for rural low-income populations, early cost-warning systems, and sustainable TB-related poverty prevention mechanisms.