Diagnosis and treatment of tuberculosis require high utilization of resources and cost-of-illness is always important for budgeting and long-term planning in a highly dynamic health care system. This study aimed to investigate the economic impact of tuberculosis and the service utilization pattern of patients with tuberculosis in Dolj County, Romania (with a population of 630,911 in 2018 from 19.3million Romanians). In this retrospective study, all patients with pulmonary tuberculosis who were registered and completed their treatment at the health network of Dolj County, from January 2018 to December 2018, were included into the study. Data were collected from the patients’ records from the health care hospitals from Craiova, Calafat, Filiasi, Dabuleni, Bailesti, Leamna. We defined the primary outcome variables for this study as the direct costs expressed in the local currency ($1=RON4.31). Among the 1099 patients (with the age: mean=48.81years, min=1year, max=92years), 266 patients (24%) were with multidrug-resistant tuberculosis and they were treated with amikacinum (5), cycloserinum (39), levofloxacinum (4), ofloxacinum (176) or protionamidum (42). The number of children <15 years with tuberculosis is 34 (3.1%). The tuberculosis rates are higher in men: 308 women (28%) and 791 men (72%), and the age-wise distribution is between the ages 35 and 64 years (640patients, 61%). The drug consumption value was RON327,170.5($75,910). The hospitalization days were in number of 100,961 with a cost of RON44,929,664($10,424,516). The costs for medical consultations (n=8,787) were RON97,327.35($22,582). The reimbursed value of the 1707 laboratory test were RON36,295.64($8,421). The total direct costs for patients with tuberculosis from Dolj is RON45,390,457($10,531,429). Our findings showed a very high value of direct costs that are reimbursed for patients with tuberculosis in Romania, representing an important economic burden, without taking into account the indirect costs as work absences necessitated by tuberculosis treatment.