Pre-treatment direct costs for people with tuberculosis during the COVID-19 pandemic in different healthcare settings in Bandung, Indonesia

The COVID-19 pandemic and the resulting Large-Scale Social Restrictions (PSBB) have significantly disrupted routine healthcare services, particularly in high TB burden countries. Despite initial expectations that the private health sector would lead in addressing TB, preliminary data suggests that the sector has shrunk or collapsed in many areas. Private facilities struggled to stay open during PSBB, and providers were reluctant to treat people with respiratory symptoms. Private healthcare costs have soared, especially for hospitalizations. Through this project, we were able to measure pre-treatment costs and factors associated with those costs from the perspective of patients during the COVID-19 pandemic in Bandung, Indonesia. It was found that the median total pre-treatment cost was $35.45 with the highest median cost experienced by participants from private hospitals. The rapid antigen and PCR for SARS-CoV-2 emerged as additional medical costs among 26% of participants recruited in private hospitals. Several factors are associated with higher pre-treatment costs including visiting more than 6 providers before diagnosis, presenting first at a private hospital and private practitioners, and being diagnosed in the private health sector. During the COVID-19 pandemic, people with TB faced significant out-of-pocket costs for diagnosis and treatment, highlighting the importance of early detection and identification in reducing pre-diagnostic TB costs.