Tuberculosis household costs exceed one-fifth of income in Korea

A national mixed-methods study found that tuberculosis-related spending exceeded 20% of pre-illness annual household income for 41.4% of households affected by drug-susceptible tuberculosis and 52.9% of those affected by drug-resistant tuberculosis in the Republic of Korea. The survey, conducted in 2024–2025, is the first national assessment of catastrophic tuberculosis costs in a high-income country, according to the researchers.

The study recruited 157 adult patients with drug-susceptible TB from selected hospitals nationwide and 17 patients with drug-resistant TB, along with five people who took part in in-depth interviews. Researchers used structured questionnaires to measure direct medical expenses, non-medical expenditures and indirect costs associated with each tuberculosis episode. They defined a catastrophic cost as total TB-related expenditure greater than 20% of a household’s annual income before tuberculosis emerged. Interviewer training, standardized data collection and supervisory oversight were used as quality-assurance measures, while semi-structured interviews were analyzed with a framework approach to examine the experiences underlying the financial figures.

Mean total costs were USD 4,515 per episode for drug-susceptible tuberculosis, with a 95% confidence interval of USD 3,473–5,557. For drug-resistant tuberculosis, the mean was USD 7,915, with a wider 95% confidence interval of USD 4,948–10,882. Although the study population was relatively small and included only 17 patients with drug-resistant disease, the results show that financial hardship remained substantial even in a country with comprehensive health insurance and free TB medical care. The investigators identified non-medical spending and lost income as especially important components of the burden faced by affected households.

Nutritional supplements were the largest single cost driver, accounting for 38.2% of total expenditure for drug-susceptible TB and 53.8% for drug-resistant TB. Post-diagnosis income loss ranked next. The interview participants described employment disruption, prolonged loss of earnings and coping strategies involving dissaving, or spending savings and other resources that could otherwise provide security. These accounts indicate that the measured burden extended beyond charges for treatment. Caregiving demands, impaired ability to work and expenses unrelated to direct clinical care also contributed to the economic consequences of tuberculosis.

The findings point to a limitation in relying on health coverage alone to prevent catastrophic costs. Free medical treatment can remove charges at the point of care, but it does not necessarily address the nutritional products, lost wages, caregiving obligations or other expenses that accumulate during an illness episode. The researchers concluded that reducing catastrophic costs in the Republic of Korea will require social protection measures that complement universal health coverage, particularly protections responding to income loss, caregiving demands and non-medical expenditure. Because the qualitative component included only five interviewees and the quantitative sample was drawn from selected hospitals, the study cannot by itself represent every household experience with tuberculosis in the country.

Subject of Research: National assessment of catastrophic tuberculosis-related household costs in the Republic of Korea

Article Title: Costs faced by households affected by tuberculosis in the Republic of Korea: a mixed-methods study

Article References: Oh, K. H., Yang, M., Jeon, D., Sohn, H., Seo, J., Chung, C., Mok, J., Kwak, N., Kim, T., Seo, K., Park, Y., Morishita, F., Grobusch, M. P., Lee, S.-E., Seo, S., Jeon, J.-H., Kang, Y. A., & Choi, H. (2026). Costs faced by households affected by tuberculosis in the Republic of Korea: a mixed-methods study. BMC Public Health. https://doi.org/10.1186/s12889-026-28579-4

Image Credits: AI Generated

DOI: 10.1186/s12889-026-28579-4

Keywords: tuberculosis, catastrophic health costs, Republic of Korea, drug-resistant tuberculosis, household finances, income loss, nutrition expenses, social protection, mixed-methods study, Costs, faced, households