Abstract: Objective To explore the economic burden of patients with pulmonary tuberculosis and risk factors, in order to provide evidences for development of tuberculosis control strategies and improving patients’ treatment adherence and treatment success rate. Methods We chose Zhangjiagang, a relatively rich county in Jiangsu province, as the study area. Twenty-three villages were selected as the study sites based on a cluster sampling me-thod. Three hundred and forty patients who were diagnosed as pulmonary tuberculosis during January 2010 and March 2013 and had already completed the standard anti-tuberculosis treatment before March 31, 2013 were invited for the investigation. We used a self-designed questionnaire to collect data on patient’s healthcare seeking experience and costs of illness. Patient’s economic burden due to the disease was analyzed and the influencing factors were explored. Eventually 274 patients accepted the investigation with the response rate of 80.6% and the questionnaire efficiency rate of 100.0%. The economic burden included two parts: direct costs and indirect costs. Direct costs included medical costs related to tuberculosis diagnosis and treatment (clinical and hospitalization expenses), transportation costs, accommodation costs and food costs. Indirect costs were calculated as loss of income due to inability to work following tuberculosis diagnosis and treatment. Considering the distribution of data, we used the mean toge-ther with the median (P25,P75) to describe the costs. We used the rank sum test (Mann-Whitney U) to compare the costs between groups. Results The average annual income of patients was 19 159.9 yuan and the median income was 15 000 yuan. The average total cost was 18 793.3 yuan and the median (P25,P75) cost was 9965 (3200-24 400) yuan. Per capita direct cost was 11 936.9 (median: 4590) yuan. After excluding costs covered by health insurance, the per capita out-of-pocket cost was 7448.0 yuan, with the median of 3315 yuan. The per capita indirect cost was 6856.4 (median: 1575) yuan. Factors associated with the economic burden included hospitalization (the average (median) out-of-pocket cost was 8512.9 (3800) yuan for patients without hospitalization history, and 24 381.4 (15 500) yuan for patients with hospitalization history, respectively. Z=－8.119, P<0.001); taking li-ver protective drugs (the average (median) out-of-pocket cost was 9911.8 (5900) yuan for patients not taking liver protective drugs, and 17 075.9 (8150) yuan for patients taking liver protective drugs, respectively. Z=－2.645, P=0.008); using the second-line anti-tuberculosis drugs (the average (median) out-of-pocket cost was 13 294.5 (6785) yuan for patients not taking second line drugs, and 18 065.3 (10 325) yuan for patients taking second line drugs, respectively. Z=－2.327, P=0.020); and diagnosis delay (the average (median) out-of-pocket cost was 12 656.5 (6110) yuan for patients with the diagnosis delay less than 14 days, and 17 457.7 (11 065) yuan for patients with the diagnosis delay over 14 days, Z=－2.970, P=0.003) etc.  Conclusion The economic burden of patients with tuberculosis in Zhangjiagang was relatively high. The costs were related to hospitalization, taking liver protective drugs and the second-line anti-tuberculosis drugs, and diagnosis delay, etc.

Key words: Tuberculosis, pulmonary/economics, Cost of illness, Fees, medical, Zhangjiagang city