Table 1.

Studies that addressed catastrophic costs included in systematic review analysis.

Author, Year/Country	Study design	Population criteria study duration	Study setting	Sample size/Sex/Age	Tool used in cost estimation	Catastrophic costs (cut-off point) Predictors of CC	Quality interpretation
Shewade, 2018/ India19	Community-based cohort study	Sputum + ve pulmonary TB ACF&PCF 3/2016 – 2/2017	Both public and private sectors	N = 465 Male: 66% Age (years): 42 ± 17	Structured questionnaire	ACF:10.3% PCF: 11.5% (20%) Predictors: not mentioned	8 (Good)
Muniyandi, 2020/ India33	Community based cross-sectional study	Pulmonary and extrapulmonary TB patients registered in NTCP 2/2017 -3/2018	Both public and private sectors	N = 384 Male:67% Mean age 38.4 ± 16	WHO-TB cost survey	31% (20%) Predictors: Lower socioeconomic segments	7 (Good)
Wingfield, 2016/ Peru44	Community-based Prospective cohort study	Any patient treated with the Peruvian NTCP DS & MDR 2/2014 – 8/2014	Public sector	N = 876 Male: 59% Age ≥ 15 years	Questionnaire	39% (20%) Predictors: Inadequate nutrition, severe TB, hidden costs and adherence	7 (Good)
Muniyandi, 2019/ India20	Community-based cross-sectional study	ACF vs PCF 10/2016—3/2018	Public sector	N = 336 Male :77% Age ≥ 15 years	Pre-coded interview schedule	PCF:29% ACF:9% (20%) Predictors: not mentioned	5 (Satisfactory)
Fuady, 2020/ Indonesia14	Hospital-based cohort study	Treatment duration ≥ 1 month or completed treatment since < 1 month DS only 7–9/ 2016	Both public and private sectors	N = 252 Male: 54% Age ≥ 18 years	Tool adapted according to the Indonesian context	46% (10%) 38% (15%) 33% (20%) 26% (25%) 22% (30%) 17% (35%) Predictors: treatment duration, and additional visits	5 (Satisfactory)
Mullerpattan, 2018/ India49	Hospital-based cross-sectional study	Drug resistant-TB, hospitalized patients 8/2015 – 2/2016	Private sector	N = 50 Male: 30% Mean age = 30 years	Not mentioned	68% (20%) 78% (10%) Predictors: not mentioned	3 (Unsatisfactory)
Lu, 2020/ China45	Both community and hospital- based cross-sectional study	Culture-confirmed DS pulmonary TB 12/2014 – 12/2015	Public sector	N = 248 Male:54.9% Mean Age = 34 (IQR 26–49)	Standardized questionnaire	22.2% (20%) Predictors: not mentioned	6 (Satisfactory)
Prasanna, 2018/ India31	Both community and hospital-based Mixed methods	Both newly diagnosed and previously treated TB patients registered for treatment under NTCP DS 1/12/2016—31/1/2017	Private sector	N = 102 Male: 69% All ages	Estimate TB, Patient’s Costs developed by the Poverty SWC of the Stops Partnership	49% (10%) 32% (20%) Predictors: Age, HIV status and Hospitalization	8 (Good)
Fuady, 2018/ Indonesia34	Primary health care centers linked to NTCP cross-sectional survey	Patients treated 1 month or finished treatment since < 1 month Not Extra-pulmonary TB TB vs MDR-TB (poor vs non poor) 7–9/2016	Not mentioned	N = 346 (282 TB—64 MDR) Male: 55% Age: ≥ 18 years	Adapted Bahasa Indonesia version	DS 36% [Poor 43%, Non poor 25%] MDR-TB 83% (20%) Predictors: Travel costs, food / nutritional supplementation costs and income loss	8 (Good)
Yang, 2020/ China36	Both community and hospital- based cross sectional study	Pulmonary TB confirmed by sputum culture Rifampicin sensitive, MDR 9–10/2018	Public sector	N = 672 Male:64.3% Median age = 41 years	WHO-TB cost survey	46% (15%) 37.1% (20%) 30.2% (25%) Predictors: Age, Senior school or above, minimum living security household, employment status, household economic status, patient delay, medical care outside the city, hospitalization, MDR	8 (Good)
Chittamany,2020/Lao PDR37	Hospital-based Cross-sectional study	TB patients on treatment in intensive (> 14 days) or continuation phase People treated under NTCP, Pulmonary and extra-pulmonary, HIV, MDR-TB 12/2018- 1/2019 & 5–6/2019	Public sector	N = 848 Male:59.7% Mean age = 50.4 years	WHO-TB cost survey	Total 62.6% DS-TB 62.2%, DR-TB 86.7%, TB -HIV Co-inf. 81.1%, at (20%) Predictors: Food & nutritional supplements, income loss, treatment phase and educational status	8 (Good)
Viney, 2019/ Indonesia38	Hospital- based cross- sectional study	Any patient received treatment ≥ 2 weeks 10/2016 – 3/2017	Public sector	N = 457 Male: 50.6% Age = 32 years (IQR 22–52)	WHO-TB cost surveys	83% (20%) Predictors: Income loss & nutritional supplements, travel and medical costs after diagnosis	9 (Very good)
Wang, 2020/ China48	Hospital-based cross-sectional study	TB-MDR finished 1 year of treatment MDR-TB 1–8/ 2018	Public sector	N = 161 Male:68.9% Age = 36 years (IQR 26–48)	Headcount tool	87% (20%) Predictors: Low household income, absence of students in a family, LOS, male gender, job and productivity loss	5 (Satisfactory)
Muttamba, 2020/ Uganda35	Hospital-based cross-sectional study	Started treatment ≥ 2 weeks DS & MDR-TB 2017	Public sector	N = 1178 Male:62.7% All ages	WHO-TB cost surveys	53% (20%) Predictors: Transport, symptom relieving medications, food and loss of income	5 (Satisfactory)
Pedrazzoli, 2018/ Ghana39	Hospital-based cross- sectional study	Patients started treatment ≥ 2weaks DS & DR-TB, HIV 2016	Public sector	N = 691 Male:67.3% Median age = 41 years (IQR 29–52)	WHO-TB cost surveys	64.1% (20%) Predictors: Income loss, DR-TB & nutritional supplements	5 (Satisfactory)
Xu, 2019/China46	Hospital-based cross-sectional study	DS, pulmonary TB, under NTCP 3–6/ 2017	Public sector	N = 1147 Male:70.7% Median age = 51 years (IQR 12- 89)	Structured questionnaire	11.7% (20%) Predictors: Region, residence and insurance	6 (Satisfactory)
Ikram, 2020/ Pakistan40	Hospital-based cross-sectional study	TB- patients diagnosed > 3 months Pulmonary & DS, without HIV, hepatitis, nor DM	Public sector	N = 400 Male:47% Median age = 30 years (IQR 22–49 .50)	WHO-TB cost surveys	67% (20%) Predictors: Availability of paid sick leave, number of follow up visits and job loss	5 (Satisfactory)
Nhung, 2018/ Viet Nam32	Community-based cross-sectional study	(DS-TB & MDR-TB) including children Started treatment at least 2 weeks All ages DS & MDR-TB 7–10/2016	Both public and private sectors	N = 735 Male:75.9% Median age = 47 years (IQR 35–58)	WHO-TB cost surveys	Total 63%, 48%, 35% MDR 98%, 98%, 39%, DS 59.6%, 43% 30% COP:(20%), (30%), (40%) Predictors: Purchase special foods, travel, nutritional supplements, and accommodation	7 (Good)
Morishita, 2016/ Cambodia50	Both hospital and community-based cross-sectional comparative study	New pulmonary TB patients without unfavorable treatment outcomes & retreatment ACF vs PCF 2012 -2013	Public sector	N = 208 (108 ACF + 100 PCF) Male: 51.9% ACF: 48.1% PCF: 56% Median age: ACF = 55 (IQR 43.8–68) PCF = 52.5 (IQR 45–62.3)	–	ACF 54.6% 36.1% 24.1% 17.6% PCF 63% 45% 34% 21% COP: (10%) (20%) (30%) (40%) Predictors: Time spent for travel, waiting, consultation and hospitalization	6 (Satisfactory)
McAllister, 2020/ Indonesia41	Hospital-based cross-sectional study	Newly diagnosed pulmonary TB patients 10/2017 – 1/2019	Both public and private sectors	N = 69 Male:49.25% Age: ≥ 18 years	WHO-TB cost surveys	38.6% (10%) 26.5% (20%) 21.7% (25%), Predictors: not mentioned	7 (Good)
Tomeny, 2020/Cavite17	Hospital-based cross-sectional study	DS-TB vs MDR-TB 5–8/2016	Both public and private sectors	N = 194 Male:66% Age: ≥ 16 years	WHO-TB cost surveys	DS-TB 28% (20%) MDR-TB 80% (20%), Predictors: Travel, accommodation, and nutritional supplement	6 (Satisfactory)
Stracker, 2019/ South Africa6	Hospital-based cross-sectional study	2 months after diagnosis, transferred patients from other health care facilities to study clinics for treatment 10/ 2017–1/2018	Public sector	N = 237 Male:54% Age: ≥ 18 years	WHO-TB cost surveys	28% (20%) Predictors: Transport, treatment, income loss and time lost in seeking care	8 (Good)
Ruan, 2016/China16	Hospital-based cross-sectional study	MDR-TB 6–8/2012	Public sector	N = 73 Male: 48% All ages	Lumley T. Survey	78% (20%) Predictors: tests, nutrition, transportation, accommodation and time loss	6 (Satisfactory)
Mudzengi, 2017/ South Africa18	Hospital-based cross-sectional study	Diagnosed 3–5 month prior to the interview TB, HIV, or Both 4–10/ 2013	Public sector	N = 454 Male:36% Age: ≥ 18 years	TB Coalition tool	Total 60% (10%) TB/HIV 79% 67% 65% 64% 61% TB only: 55% 53% 47% 47% 45% HIV only: 72% 60% 55% 52% 49% COP: (5%), (10%),(15%), (20%), (25%)	7 (Good)
Gurung, 2019/ Nepal42	Hospital-based cross-sectional study	New and relapsed patients with TB (ACF vs PCF) 4–10/2013	Public sector	N = 99 Male:71% Age: ≥ 18 years	WHO-TB cost surveys	Total 52% PCF 61% ACF 44% (20%) Predictors: gender, age, disease category (new, relapse), poverty line, dissaving, financial and social impact	7 (Good)
Walctt, 2020/ Uganda15	Hospital-based retrospective cohort study	Spoke Luganda or English, confirmed active pulmonary TB Newly diagnosed TB 7–9/2017	Public sector	N = 224 Male:60.2% age: ≥ 18 years	Adapted version of Tool to Estimate Patients' Cost (stop TB partnership)	41.8% (20%) Predictors: Hospitalization, experience of coping costs, low-income status, age, education, HIV, unemployment, and female gender	6 (Satisfactory)
Rupani, 2020/ India51	Cross-sectional study	Patients not previously treated DS pulmonary TB 1/2019	Public sector	N = 458 Male:70% Median age = 35 (IQR 23–50)	WHO-TB cost surveys	14% (10%) 7% (15%) 4% (20%) Predictors: not mentioned	7 (Good)
Timire, 2020/ Zimbabwe43	Hospital-based cross-sectional study	Patients with DS or MDR TB 23/7–31/-8 2018	Public sector	N = 900 Male:56% Mean age: 36.9 ± 14.7	WHO-TB cost surveys	80% (20%) Predictors: Gender, Age, TB type, treatment phase, treatment delay HIV status, breadwinner, income quintile, and location of health facility	5 (Satisfactory)
Gadallah, 2018/ Egypt47	Hospital-based. prospective cohort study	New TB patients attending TBMUs for starting their treatment 1–6/2019	Public sector	N = 257 Male:61.9% Mean age: 38.3 ± 14.8 years	WHO-TB cost surveys	22.6% (10%) 24.1% (20%) 6.6% (30%) Predictors: Age, gender, unemployment, crowding index, governorates, income,	5 (Satisfactory)

ACF Active case finding, PCF Passive case finding, SP Smear Positive, TB Tuberculosis, DS Drug sensitive, HIV Human immunodeficiency virus, LOS Length of stay, MDR Multi-Drug Resistant, NTCP National TB Control Program, SWC Sub-Working Group, TBMU Tuberculosis medical unit.