Costs faced by households affected by tuberculosis in the Republic of Korea: a mixed-methods study
Abstract
Background: Tuberculosis (TB) continues to impose substantial financial hardship on affected households in low- and middle-income countries. Until recently, no published evidence was available from high-income countries. This study presents the first national TB household cost survey conducted in the Republic of Korea, a high-income country, to assess the magnitude and drivers of catastrophic costs and explore underlying socioeconomic mechanisms.
Methods: A mixed-methods study was conducted in 2024–2025. Adult patients with drug-susceptible TB (DS-TB) and drug-resistant TB (DR-TB) were recruited from selected hospitals nationwide. Structured questionnaires quantified direct medical, non-medical, and indirect costs. Catastrophic costs were defined as total TB-related expenditure exceeding 20% of pre-TB annual household income. Quality assurance included interviewer training, standardised data collection protocols, and supervisory oversight during data collection. For the qualitative component, semi-structured in-depth interviews were conducted with purposively selected participants and analysed using a framework approach.
Results: A total of 157 patients were included (140 DS-TB and 17 DR-TB), alongside five qualitative interviewees. Mean total costs per TB episode were USD 4,515 (95% CI, 3,473–5,557) for DS-TB and USD 7,915 (95% CI, 4,948–10,882) for DR-TB. Nutritional supplements were the largest single cost driver (38.2% of the total cost for DS-TB and 53.8% for DR-TB), followed by post-diagnosis income loss. Catastrophic costs affected 41.4% of DS-TB and 52.9% of DR-TB households. Qualitative findings revealed widespread employment disruption, sustained income loss, coping through dissaving, and psychosocial distress.
Conclusions: Despite comprehensive health insurance and free TB medical care, TB-affected households in Korea face substantial non-medical and indirect costs. Eliminating catastrophic costs will require social protection measures addressing income loss, caregiving demands, and non-medical expenditures alongside universal health coverage.
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BibTeX
@article{oh2026costs,
title = {{Costs faced by households affected by tuberculosis in the Republic of Korea: a mixed-methods study}},
author = {Kyung Hyun Oh and Minjoo Yang and Doosoo Jeon and Hojoon Sohn and Jeungeun Seo and Chiwook Chung and Jeongha Mok and Nakwon Kwak and Taehoon Kim and Kang Seo and Youngmok Park and Fukushi Morishita and Martin P. Grobusch and Seung-Eun Lee and Soonryu Seo and Jin-Hwan Jeon and Young Ae Kang and Hongjo Choi},
journal = {BMC Public Health},
year = {2026},
month = oct,
doi = {10.1186/s12889-026-28579-4},
url = {https://link.springer.com/10.1186/s12889-026-28579-4},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Costs faced by households affected by tuberculosis in the Republic of Korea: a mixed-methods study
AU - Kyung Hyun Oh
AU - Minjoo Yang
AU - Doosoo Jeon
AU - Hojoon Sohn
AU - Jeungeun Seo
AU - Chiwook Chung
AU - Jeongha Mok
AU - Nakwon Kwak
AU - Taehoon Kim
AU - Kang Seo
AU - Youngmok Park
AU - Fukushi Morishita
AU - Martin P. Grobusch
AU - Seung-Eun Lee
AU - Soonryu Seo
AU - Jin-Hwan Jeon
AU - Young Ae Kang
AU - Hongjo Choi
PY - 2026
DA - 2026/10/07
JO - BMC Public Health
DO - 10.1186/s12889-026-28579-4
UR - https://link.springer.com/10.1186/s12889-026-28579-4
AB - Background: Tuberculosis (TB) continues to impose substantial financial hardship on affected households in low- and middle-income countries. Until recently, no published evidence was available from high-income countries. This study presents the first national TB household cost survey conducted in the Republic of Korea, a high-income country, to assess the magnitude and drivers of catastrophic costs and explore underlying socioeconomic mechanisms. Methods: A mixed-methods study was conducted in 2024–2025. Adult patients with drug-susceptible TB (DS-TB) and drug-resistant TB (DR-TB) were recruited from selected hospitals nationwide. Structured questionnaires quantified direct medical, non-medical, and indirect costs. Catastrophic costs were defined as total TB-related expenditure exceeding 20% of pre-TB annual household income. Quality assurance included interviewer training, standardised data collection protocols, and supervisory oversight during data collection. For the qualitative component, semi-structured in-depth interviews were conducted with purposively selected participants and analysed using a framework approach. Results: A total of 157 patients were included (140 DS-TB and 17 DR-TB), alongside five qualitative interviewees. Mean total costs per TB episode were USD 4,515 (95% CI, 3,473–5,557) for DS-TB and USD 7,915 (95% CI, 4,948–10,882) for DR-TB. Nutritional supplements were the largest single cost driver (38.2% of the total cost for DS-TB and 53.8% for DR-TB), followed by post-diagnosis income loss. Catastrophic costs affected 41.4% of DS-TB and 52.9% of DR-TB households. Qualitative findings revealed widespread employment disruption, sustained income loss, coping through dissaving, and psychosocial distress. Conclusions: Despite comprehensive health insurance and free TB medical care, TB-affected households in Korea face substantial non-medical and indirect costs. Eliminating catastrophic costs will require social protection measures addressing income loss, caregiving demands, and non-medical expenditures alongside universal health coverage.
SN - 1471-2458
ER -