The Household Costs of Visceral Leishmaniasis Care in South-eastern Nepal

Abstract

Background and objectivesVisceral leishmaniasis (VL) is an important public health problem in south-eastern Nepal affecting very poor rural communities. Since 2005, Nepal is involved in a regional initiative to eliminate VL. This study assessed the economic impact of VL on households and examined whether the intensified VL control efforts induced by the government resulted in a decrease in household costs.MethodsBetween August and September 2010, a household survey was conducted among 168 patients that had been treated for VL within 12 months prior to the survey in five districts in south-eastern Nepal. We collected data on health-seeking behaviour, direct and indirect costs and coping strategies.ResultsThe median total cost of one episode of VL was US$ 165 or 11% of annual household income. The median delay between the onset of symptoms and presentation to a qualified provider was 25 days. Once the patient presented to a qualified provider, the delay to correct diagnosis was minimal (median 3 days). Direct and indirect costs (income losses) represented 47% and 53% of total costs respectively. Households used multiple strategies to cope with the cost of illness, mainly mobilizing cash/savings (71%) or taking a loan (56%).ConclusionsThe provision of free VL diagnosis and drugs by the Nepalese control programme has been an important policy measure to reduce the cost of VL to households. But despite the free VL drugs, the economic burden is still important for households. More effort should be put into reducing indirect costs, in particular the length of treatment, and preventing the transmission of VL through vector control.

The direct costs of treating human visceral leishmaniasis in Brazil

“…The effects of VL on the economy are evident because this disease mainly affects low-income populations, and the direct and indirect costs related to diagnosis and treatment are high [21][22][23] .…”

Social and Economic Burden of Human Leishmaniasis

“…10 A recent study in Nepal showed that indirect cost increased from 47% in 2006 9 to 53% in 2010. 11 This may be because most affected individuals live in remote villages that are far away from the free government health-care facilities, which are usually located in the cities and urban centers. Because leishmaniasis is primarily more common in rural areas and villages, many of the affected individuals patronize the more expensive and often inadequate private health-care facilities located in these villages.…”

“…In another study, 51% of households exceeded catastrophic threshold of 10% of the annual household income. 11 It is interesting to note that without the provision of free drugs, the catastrophic index would have increased from 51-74%. 11 The implication of catastrophic payments may be seen as changes in treatment-seeking behavior from the formal to informal health sector.…”

“…11 It is interesting to note that without the provision of free drugs, the catastrophic index would have increased from 51-74%. 11 The implication of catastrophic payments may be seen as changes in treatment-seeking behavior from the formal to informal health sector. 10 Factors such as distance to facility, cost, staff, regularity of supplies, and cultural preferences can influence a person's choice of health-care provider, which may have significant impact on timeliness of diagnosis, treatment, and effectiveness.…”

Elimination of visceral leishmaniasis on the Indian subcontinent

“…They suggest that every rupee invested in VL control in Nepal at present (2010) will yield 71 rupees in future. (51). Yet investments are required, and strong commitments from political stakeholders as well as funding agencies are crucial to achieve the elimination goal.…”