Household expenditure on leprosy outpatient services in the Indian health system: A comparative study

Background: Leprosy is a major public health problem in many low and middle income countries, especially in India, and contributes considerably to the global burden of the disease. Leprosy and poverty are closely associated, and therefore the economic burden of leprosy is a concern. However, evidence on patient’s expenditure is scarce. In this study, we estimate the expenditure in primary care (outpatient) by leprosy households in two different public health settings. Methodology/Principal findings: We performed a cross-sectional study, comparing the Union Territory of Dadra and Nagar Haveli with the Umbergaon block of Valsad, Gujrat, India. A household (HH) survey was conducted between May and October, 2016. We calculated direct and indirect expenditure by zero inflated negative binomial and negative binomial regression. The sampled households were comparable on socioeconomic indicators. The mean direct expenditure was USD 6.5 (95% CI: 2.4–17.9) in Dadra and Nagar Haveli and USD 5.4 (95% CI: 3.8–7.9) per visit in Umbergaon. The mean indirect expenditure was USD 8.7 (95% CI: 7.2–10.6) in Dadra and Nagar Haveli and USD 12.4 (95% CI: 7.0–21.9) in Umbergaon. The age of the leprosy patients and type of health facilities were the major predictors of total expenditure on leprosy primary care. The higher the age, the higher the expenditure at both sites. The private facilities are more expensive than the government facilities at both sites. If the public health system is enhanced, government facilities are the first preference for patients. Conclusions/Significance: An enhanced public health system reduces the patient’s expenditure and improves the health seeking behaviour. We recommend investing in health system strengthening to reduce the economic burden of leprosy. Author summary: Leprosy leads to low quality of life even after cure. The anaesthetic hands and feet leading to ulcers and deformities, stigma and poor mental health are just a few challenges. After declaration of leprosy elimination at global level, the research activities reduced significantly, and the health economics aspect was not an exception. The knowledge on economic burden of a disease helps in prioritization, policy making and advocacy. Our study is a step towards quantifying the economic burden of leprosy. Currently the aim is to eliminate leprosy at national level, therefore the countries need more information to plan high impact activities. Moreover, the patient’s perspective is important as they are the end-point recipients. Our study explores the patient’s financial burden due to leprosy (outpatient services), which is a significant indicator of a public health program’s success. If invested properly, the public health system has potential to reduce the economic burden of public health diseases. Our study is an attempt to link the patient’s perspective with the health system performance. This will help to encourage health systems strengthening.