Out-of-pocket costs for people with tuberculosis disease in Toronto, Canada: A web-based survey at two tuberculosis...

In Ontario, over 600 cases of tuberculosis (TB) have been reported annually since 2015. Despite publicly funded health care, the direct and indirect costs to individuals have not been well studied and may be substantial.

To assess the economic and social impacts of TB among individuals undergoing treatment at specialized TB care centers in Toronto, Canada.

Patient-reported costs, work disruptions, social consequences and changes in household financial status were evaluated. A cross-sectional web-based survey was conducted among adults (18 years and older) receiving TB treatment at West Park Healthcare Centre and the Toronto Western Hospital TB clinic between April 2023 and April 2025. Respondents completed a modified version of the World Health Organization's Tuberculosis patient cost survey, which collected data on out-of-pocket costs, work loss and social outcomes. Descriptive statistics were used to summarize key findings and reported costs in 2025 Canadian dollars.

A total of 42 people with TB disease completed the survey (mean age=36.7 years; 38% female). The mean cost of a TB-related appointment was $42.82 (standard deviation [SD]=$47.89), with variation by treatment center, hospitalization status and transportation method to appointments. More than half (61.9%) of respondents reported missing work due to treatment, with a mean loss of 130 hours (SD=141). Following diagnosis with TB, 28.6% of respondents experienced job loss, and 45.3% of respondents experienced a worsening of their household financial situation, with 16.7% reporting that it had become much worse.

Despite publicly funded health care, people with TB face economic and social challenges. These findings will contribute to a deeper understanding of the financial challenges faced by people with TB and may be useful in informing public health policy.