Economic Burden of Tuberculosis in Iran: A Nationwide Analysis by Drug Resistance and Cost Components.

BACKGROUND: Tuberculosis (TB) remains a significant global health crisis, regaining its status as the leading cause of death in 2023. Quantifying its economic burden is essential for crafting effective public health strategies. This study aimed to estimate the economic burden of TB in Iran. Study Design: This study employed a cross-sectional design. METHODS: A prevalence-based approach was used to estimate the economic burden of TB in Iran, accounting for cost variations across TB types and cost categories. Costs were categorized as direct medical, direct non-medical, and indirect, and were calculated for suspected TB patients as well as for those with drug-sensitive TB, multidrug-resistant TB, and extensively drug-resistant TB. Data were extracted from various sources, including the National Tuberculosis Registration System, national TB diagnosis and treatment guidelines in Iran, official medical service tariffs, and previous studies. RESULTS: Of 210,544 individuals screened, 7,221 were diagnosed with TB, of whom 81.0% had pulmonary TB and 19.0% had extrapulmonary TB. Drug-sensitive TB accounted for 99.4% of cases, multidrug-resistant TB 0.6%, and extensively drug-resistant TB 0.0%. Diagnostic costs represented 48.0% of the total economic burden (approximately Int'l$4.71 million), while post-diagnosis costs totaled Int'l$5.15 million. Overall, economic burden, including all diagnostic and treatment expenses, amounted to approximately Int'l$9.86 million. CONCLUSION: This study underscores the significant economic burden of TB in Iran, encompassing both pre-diagnosis and post-diagnosis expenses, with direct medical costs representing the largest component. Effective healthcare strategies and comprehensive public health approaches are crucial to reducing these costs and improving patient outcomes.