Household cost-of-illness of visceral leishmaniasis in Bihar, India.

OBJECTIVE To determine the cost of kala-azar (KA) to patients in Bihar, India. METHOD A semi-structured questionnaire was used to collect costs of illness--direct (medical; non-medical) and indirect costs (work days lost). After screening the community known to be endemic for visceral leishmaniasis (VL), households (HHs) with VL were recruited which reported a case of KA who received treatment between September 2005 and September 2006. The total costs were calculated as a summation of individual costs category. Medians were estimated for the total and for each of the cost categories. RESULT Data from 171 HHs and 183 patients revealed that median age of patients with KA was 18; 59% were men; 33% were employed; household size was 7; household median monthly income was $38. The median total costs per patient were $127, equal to >3 months of income, of which medical care comprised $83 (provider fees $13, medicines $50, diagnostics $9, hospital stay $30); and food and transport comprised $33. Patients also lost almost 2 weeks of work time during illness and even after recovery. CONCLUSION Despite provision of free/subsidized medicines, diagnostics, and hospital stay at public and Non-Governmental Organization facilities, the impoverished HHs of Bihar with a case of KA incur high expenditures. Easier access to, and more use of free public health services, plus innovative health financing schemes, are urgently required.