A micro-costing analysis of tuberculosis care in England: a bottom-up evaluation of treatment and service delivery costs

Background

In 2024 incidence of tuberculosis in England rose to 9.4 per 100,000, which is close to exceeding the low-incidence designation threshold. Addressing the rising incidence requires policy making to ensure sufficient staff, hospital resources and budgets are available to meet the increasing demand. However, costing of active pulmonary TB in the UK are limited and better clarity is needed on the clinical pathway of tuberculosis and the resources involved.

Objective

This study aims to estimate the costs of active pulmonary drug-sensitive tuberculosis care in England using a micro-costing approach.

Method

The analysis was performed from the perspective of the National Health Service (NHS), capturing direct medical costs only. The clinical pathway for different severities of tuberculosis care was defined through a review of the literature, clinical guidelines, and interviews with clinicians.

Costs were mainly drawn from the British National Formulary and the eMIT national database for drug costs, and the National Cost Collection (2021-22) for diagnostics, monitoring, nursing and hospitalisation alongside a desk-based review.

Results

Per-patient costs in 2021 ranged from approximately £2,000 for community-managed cases to over £50,000 for the most complex patients. An estimated 70% of patients cost between £4,971 and £7,307. The weighted average cost of treatment across all complexities was £8,125 per patient reflective of the proportion of cases at each severity. For the 4,423 patients in 2021, it is estimated that the costs of direct treatment were at least £36 million pounds, highlighting the significant financial implications of increasing tuberculosis.

Conclusion

The findings demonstrate that tuberculosis care imposes a substantial and highly variable cost burden on the NHS. Overall, this study provides cost estimates that can inform service planning, resource allocation, and future economic evaluations. Further research is needed on the costs of drug-resistant TB to support comprehensive TB control strategies.

What is already known on this topic?

Existing UK evidence on tuberculosis costs is limited with little detailed micro-costing of the full care pathway.

What this study adds?

This study provides granular, bottom-up estimates of tuberculosis care costs in England, demonstrating the drivers of costs and the substantial variation by disease complexity and severity.

How this study might affect research, practice or policy?

These findings can inform resource allocation and economic evaluations, supporting policies that prioritise early diagnosis and community-based care to reduce costs and healthcare burden.