Box 1 Operational definitions

Calculation of out-of-pocket expenditure (OOPE) incurred by the PwTB [19]

Direct costs

Direct costs included all OOPE incurred by PwTB during TB diagnosis and treatment. Medical expenses included OOPE on consultation or registration fees, drugs, and diagnosis. Non-medical expenses included expenditure on transport, accommodation, food, and additional food supplements costs. Reimbursement or cashless transfer received through insurance schemes were subtracted from the direct costs.

Indirect costs

Indirect costs included the income (or productivity) lost due to inability or reduced ability to work because of the TB illness. It also included the income lost due to time spent on hospital visits for diagnosis, drug collection, travel and waiting time etc.

Coping costs

Coping costs were the costs of coping mechanisms adopted by PwTB and households to meet the expenditure due to TB care. These included, but were not limited to, costs due to interest on borrowed loan, loss incurred due to sales of assets, and dissolution of savings.

Total costs

Total costs were a sum of the direct, indirect and coping costs incurred during TB diagnosis and treatment.

The costs incurred during TB diagnosis and treatment were calculated as those incurred during (1) pre-diagnosis, (2) treatment and follow-up visits, (3) hospitalization.

All costs were calculated for both the PwTB and the caregiver(s).

Pre-diagnosis costs

The pre-diagnosis costs included the direct and indirect costs incurred by the PwTB from the onset of first symptom in the current cascade of events that led to diagnosis of TB till the date when the diagnosis was confirmed.

Treatment and follow-up costs

The treatment and follow-up costs included the direct and indirect costs incurred by the PwTB from the initiation of treatment till declaration of the treatment outcome.

Hospitalization costs

Hospitalization costs included the direct and indirect costs incurred during every episode of hospitalization during pre-diagnosis or treatment/follow-up period.

Catastrophic costs

Total costs incurred by the PwTB during TB diagnosis and treatment, exceeding a given threshold (e.g. 20%) of the household’s annual pre-TB income [37]. Household income was calculated as a sum of income from salary and all other sources for all of the members of the household.