The burden of out-of-pocket and indirect costs of cutaneous leishmaniasis patients in Minas Gerais, Brazil

Background: Healthcare expenses represent a proportionally greater burden for the poorest populations, which further exacerbates the negative impact of the disease on the individual’s quality of life and productivity. Objective: The study aimed to identify the direct and indirect costs during the treatment of cutaneous leishmaniasis (CL) from the patients’ perspective and examine factors influencing the costs burden among CL patients. Methods: A prospective cost analysis was conducted between April 2022 and April 2023 through interviews with patients with a confirmed diagnosis of CL. Direct costs were estimated using the micro-costing approach, and indirect costs using the human capital method. Descriptive analyses and hypothesis tests were conducted for associations between costs and sociodemographic and clinical variables, with a significance level of 5%. Results: The study included 68 patients, predominantly male (77.9%) with an average age of 53 years. Cutaneous leishmaniasis was the most common clinical form (76.4%), with new cases accounting for 79.4% of participants. Patients averaged 3.5 outpatient visits per CL treatment cycle, with miltefosine and intravenous meglumine antimoniate being the most prescribed therapies. Direct costs per treatment cycle averaged USD 117.36, attributed to transportation, food, and medical exams. Indirect costs from lost workdays amounted to USD 9,936.58, with an average of USD 160.12 per patient. Catastrophic expenditure (>10% of monthly income) was observed in 42.6% of families, significantly associated with direct cost, bacterial infection, and sociodemographic factors such as gender, age, and distance traveled. Conclusions: This study underscores the substantial economic burden of CL treatment on patients, highlighting the need for targeted interventions to mitigate financial hardship, particularly among vulnerable socioeconomic groups. Author Summary: Cutaneous leishmaniasis (CL) is a neglected disease that mainly affects the most vulnerable populations in tropical and subtropical countries. The disease causes lesions on the skin and mucous membranes that can lead to physical effects, functional impairment and loss of productivity, as well as psychological and economic impacts on individuals. Although the disease is common in some regions, there are few treatment options, many of which are toxic and require monitoring. Many patients are referred to specialised services that receive patients from different regions to diagnose and treat the disease. In this study, patients at a referral centre were asked about the out-of-pocket expenses they have to pay while receiving treatment for CL that are not covered by the health system, such as transport, food, medicines, services and absence from work. The results of these studies will be important in measuring costs from the patient’s perspective and understanding the impact that costs during treatment for CL can have on family income.