Economic impact of a large-scale scabies upsurge on healthcare facilities in Rohingya refugee camps: A retrospective costing study

Scabies is one of the common infectious skin conditions globally, with a significantly high burden in hot and tropical countries, and resource-poor settings. Rohingya refugee camps in Cox’s Bazar are one of the most protracted refugee crises in the world, sheltering approximately 1,143,096 refugees. While most existing literature focuses on mass drug administration (MDA) interventions or community-level estimates, the economic burden of scabies on health system is rarely studied. This is a retrospective costing study, where we used financial and epidemiological data from January 2021 to December 2024. Costing was done from the provider's perspective, focused on what International Organization for Migration (IOM) spent during the period as a health service provider. A combination of standard stepdown approach and micro-costing methods were used. Financial data were collected from the IOM health programme’s annual budget and consumption reports. The study population included all individuals who were clinically diagnosed with scabies and received care at 35 IOM-supported health facilities in Cox’s Bazar, Bangladesh. The overall estimated financial cost for IOM’s scabies outbreak response was USD 2.12 million, with an annual average of USD 531,729. The average cost per scabies management ranged between USD 5.33 and USD 6.54. Drug costs accounted for 11.92% of the overall cost over 4 years. Of the total cost of USD 253,629.43 over 4 years, 79% was attributed to permethrin topical cream, which was used to manage an estimated 85% of the total managed cases. Scenario analyses demonstrates that the existing permethrin-based treatment preference is the most expensive treatment modality, compared with ivermectin-based treatment and mixed-treatment approaches. Although the average cost of treating scabies is relatively low, overall, the treatment cost for such a large population has a significant economic impact. This study found a substantial effect of MDA on reducing the financial burden on the healthcare system.