Household costs and health-related quality of life of childhood MDR-TB in Western Cape, South Africa

Background Multidrug-resistant (MDR) tuberculosis (TB) in children remains a major public health challenge. Although treatment is provided free of direct charge in many countries, it can impose substantial indirect and non-medical costs on affected households. Evidence on the economic burden of childhood MDR-TB on families, remains limited. Methods A cross-sectional household survey was conducted in the Western Cape, South Africa, among 45 households with a child <15 years who initiated MDR-TB treatment between 2018 and 2021. Socioeconomic status, costs of accessing care, and health-related quality of life (HRQoL) were assessed and linked to health service utilisation data to estimate household-level costs. Results The median total cost per household was ZAR 7,443 (US$504) per episode of care (IQR: ZAR 4,119 to 13,207), with indirect costs accounting for the largest share of household costs. Twenty-three (51.1%) of the households incurred catastrophic health expenditure, defined as >20% of annual household income. Costs increased with hospital-based care, longer treatment duration, and more frequent caregiver visits. The HRQoL of children was generally high, though not uniformly distributed. Conclusions Childhood MDR-TB places a substantial financial burden on already vulnerable households. Economic evaluations and care models should incorporate household costs and consider strategies to reduce the indirect burden of treatment on families.