Pulmonary tuberculosis remains an important infectious disease that imposes a significant health and economic burden on patients and the healthcare system. This study aimed to describe the structure of direct medical costs for inpatient pulmonary tuberculosis treatment at Thai Nguyen Lung Hospital in 2025. A cross-sectional descriptive study was conducted on 294 medical records and hospital billing statements of inpatients with pulmonary tuberculosis. The average total treatment cost per patient was 7,152,546 VND, of which health insurance covered 80.3% of the total cost. The mean out-of-pocket cost per treatment episode was 1,408,917 VND. Among patient-paid expenses, hospital bed costs accounted for the largest proportion (42.4%), followed by laboratory tests (35.8%), while the cost of anti-tuberculosis drugs accounted for only 0.9%. These findings indicate that health insurance plays an important role in reducing the financial burden of tuberculosis treatment; however, inpatient service costs and laboratory tests still represent a considerable proportion of patient-paid expenses. Therefore, further improvement of health insurance reimbursement policies and optimization of treatment management are necessary to reduce the economic burden on tuberculosis patients.