INTRODUCTION:
the costs associated with tuberculosis (tb) treatment can impose significant economic burdens on patients and their families. this study aimed to assess the total costs incurred by families of individuals with tb in brazil to identify impoverishment resulting from diagnosis and treatment.

METHODS:
a cross-sectional survey was conducted between september 2019 and march 2021 in 35 municipalities across brazil, involving individuals diagnosed with tb. an instrument adapted from the world health organization protocol was used. the results were obtained using the survey package in r version 4.0.1. statistical significance was defined as p < 0.05.

RESULTS:
the costs faced by families of patients in brazil were substantial. among 603 affected households, 48.1% (95% ci: 43–53.2) experienced costs exceeding 20% of their annual household income during the tb episode. patients incurred total costs of us$1573 (95% ci: 1361.8–1785.0) per tb episode, including prediagnosis and postdiagnosis expenses. key cost drivers were postdiagnosis nutritional supplements (us$317.6, 95% ci: 232.7–402.6), followed by medical expenses (us$85.5, 95% ci: 54.3–116.5) and transportation costs for clinic visits during treatment (us$79.2, 95% ci: 61.9–96.5). the mean total cost corresponded to 7.8 minimum wages, and the average time of work lost was 64.4 hours. the proportion of tb-affected households with self-reported income below the poverty line doubled from 4.3% (95% ci: 2.7–6.3) prior to tb to 10.9% (95% ci: 8.1–14.2).

CONCLUSIONS:
despite the provision of free treatment, patients bore substantial costs. identifying these costs underscores the need to strengthen national policies related to food security, social assistance, and employment to mitigate the financial impact of tb on patients.