Initial clinical experience with total Müllerian compartment resection for locally advanced cervical cancer: a single-center preliminary retrospective cohort study and learning-curve analysis.

Tuberculosis (TB) remains a critical global public health challenge with profound socioeconomic implications, particularly affecting impoverished populations. TB-affected households facing catastrophic costs have emerged as a significant barrier to sustainable development in high-burden regions. Eliminating catastrophic TB costs constitutes a fundamental pillar of the WHO End TB Strategy (, ). Current evidence demonstrates substantial heterogeneity in TB-related economic burden across geographical regions and demographic groups, with vulnerable populations disproportionately affected (). As a high-burden country accounting for approximately 6.8% of global tuberculosis cases (ranking third worldwide) (), China faces significant challenges in mitigating the economic impact of TB. Reducing catastrophic costs among TB-affected households represents a critical component of national efforts to eliminate TB-associated morbidity, alleviate poverty, and achieve the targets of both the WHO End TB Strategy and China’s Healthy China 2030 objectives (). The Chinese government has implemented comprehensive TB control measures, including free treatment policies and enhanced medical insurance coverage (). Specifically, the state provides free sputum smear and chest X-ray examinations for presumptive TB cases and offers free first-line anti-TB drugs and basic examinations during treatment for active pulmonary TB patients. In terms of medical insurance, TB has been included in outpatient special disease or chronic disease management schemes in many regions, with inpatient reimbursement rates within the policy scope remaining stable at approximately 70% in some areas (). In addition, China has continuously optimized its TB service delivery system, transitioning from a Centers for Disease Control and Prevention (CDC)-led model to a “trinity” model, in which the CDC is responsible for planning and management, designated medical facilities undertake diagnosis and treatment, and primary healthcare facilities handle patient follow-up (). Through government leadership and multi-sectoral collaboration, this model has achieved a full-chain, closed-loop management system from case detection to cure and has basically enabled ordinary TB diagnosis and treatment to be completed within counties. However, this model still has shortcomings in alleviating patients’ financial burden. On the one hand, due to different operational mechanisms between designated hospitals and the CDC, some hospitals exhibit non-standardized practices and over-treatment, which drive up patient costs. On the other hand, under the current medical insurance system, the outpatient reimbursement rate and cap for TB patients remain limited. Moreover, some costs incurred before diagnosis, direct non-medical costs such as transportation and accommodation, and indirect costs such as income loss due to work absence are not covered by insurance (). As a result, the disease-related economic burden on patients remains substantial, and previous studies have shown that this burden is still serious in some regions (, ). The Guangxi Zhuang Autonomous Region (Guangxi), an economically underdeveloped region in southwestern China, bears a disproportionately high TB burden, with surveillance data from the past decade consistently showing that TB ranks among the top two reported Class A/B infectious diseases in the region and that Guangxi remains among China’s seven highest-burden provinces (, ). Since 2003, the region has implemented WHO-recommended TB control strategies through the World Bank/UK Grant-funded project, providing free diagnostic services (including chest radiography and sputum smear microscopy) and first-line anti-tuberculosis medications. Other medical expenses have been reimbursed through the national basic medical insurance system, and the TB control service system is being optimized continuously (). However, this package of policy measures is still not enough to solve the economic burden on TB patients (). There is an urgent need to comprehensively evaluate the economic burden on TB patients, but research on catastrophic costs due to TB is scarce. The purpose of this study was to investigate the treatment costs of TB patients and to analyze the current situation of catastrophic costs due to TB and their associated factors. The findings will inform targeted poverty alleviation strategies in Guangxi while providing transferable evidence for other high-burden regions in China.