Tuberculosis costs EU €5.9 billion per year


The economic burden of tuberculosis (TB) in the European Union amounts to a total of €5,898,298,315 per year, according to a conservative calculation. This is the conclusion of a scientific study, published today in the European Respiratory Journal, led by the University Hospital Schleswig-Holstein in Kiel, Germany.

Because very little was known about the costs of TB disease in the EU, a group of European and US scientists did a systematic review of literature and institutional websites. The scientists distinguished direct costs (medication, hospitalisation and outpatient cost) and indirect costs (loss of productivity and the monetary equivalent of Disability-Adjusted Life-Years DALYs (overall disease burden)), as well as costs to treat susceptible TB (‘normal’ TB, responding to standard TB drugs), MDR-TB (Multi drug-resistant TB, resistant to several drugs) and XDR-TB (Extensively drug-resistant TB, resistant to a large number of drugs). The latter distinction is important with regard to the dramatic increase of MDR-TB and XDR-TB in the world.

Conservative calculations
According to very conservative calculations – several data were not available and therefore several costs not included or calculated conservatively – the direct costs of TB in the EU add up to about €537 million per year. The cost of treatment of susceptible TB cases in the 18wealthier EU countries1) is estimated at €7,848 per case, whereas the costs to treat MDR-TB cases and XDR-TB cases are estimated at €54,779 and €168,310 respectively.  Due to lack of data the cost of treatment of susceptible TB patients in the 9 remaining ‘new’ EU member states2) are estimated at one third of the mean in the ‘wealthier’ EU member states: €2,616. The cost of treatment of MDR-TB and XDR-TB patients in these countries are estimated at €24,166.

The loss of productivity is calculated at €2,434 per patient, regardless of drug susceptibility, for the 18 wealthier EU countries, and €811 for the remaining 9 countries. Combined with the direct costs and the monetary equivalent of Disability-Adjusted Life-Years (DALYs) due to TB of €5,361,408,000 this adds up to about €5.9 billion overall cost for TB in the European Union. 

Real costs might be twice as high
“Taken into account the many conservative assumptions, the amount of direct costs are likely to be much higher than calculated in our study,” says Dr Roland Diel, Professor of Health Economy at the University Hospital Schleswig-Holstein in Kiel and first author of the scientific paper. “It wouldn’t surprise me if the real direct costs including staff costs of Public Health institutions established to control TB on a nationwide level would be approximately twice as high as we calculated. From personal information from experts in several countries all over Europe, we know that the costs calculated by us are too low, but we wanted to publish undeniable, published data to prevent any discussion.”

Costs likely to increase
Dr Joris Vandeputte, co-author of the article, says: “We now have a clear indication that the cost of TB, even in the wealthy European Union where many people think TB is a disease of the past, is many times higher than most people realize. With the threatening rise of MDR-TB and XDR-TB, not only in Europe, but in the whole world, it is likely that these costs will increase in the next future.”

Business case for development of vaccines
Dr Jelle Thole, director of TBVI, taking note of these new data adds: “We recently developed a business case for the development of new vaccines, where we calculated that it will cost approximately €600 million to develop a new vaccine for TB. Although this amount is considerable, it is relatively small related to the yearly cost of TB in Europe alone. We hope this information will convince more donors to invest in live-saving TB vaccines, because without better vaccines it is unlikely that tuberculosis will ever be eliminated."


[1] Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Malta, Netherlands, Portugal, Slovenia, Spain, Sweden, United Kingdom

[1] Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland,  Romania, Slovakia