Understanding the economic impact of leishmaniasis on households in endemic countries: a systematic review

ABSTRACT

Introduction: Leishmaniasis is a poverty-related disease that causes a significant socioeconomic burden to affected households. Visceral leishmaniasis is fatal if untreated, yet illness costs may lead to delays in accessing care. Skin manifestations of leishmaniasis cause a psychological burden and even longer treatment trajectories. The objective of this review is to evaluate illness costs associated with leishmaniasis across different settings (Asia, Africa, and Latin America) and the consequences to households.

Areas covered: Through a systematic review of cost-of-illness studies, we documented the distribution of costs, the health-seeking behavior, and the consequences of leishmaniasis. We discuss the value of cost-of-illness studies for leishmaniasis.

Expert commentary: Despite the free provision of diagnostics and treatment in the public health care sector, out-of-pocket payments remain substantial. There has been progress in addressing the economic burden of leishmaniasis, particularly through the elimination initiative in the Indian subcontinent. Though the illness cost is decreasing due to shorter treatment regimens and better access to care, the situation remains challenging in Africa. Improvement of control tools is critical. There is a need to update cost estimates to inform policy-making and ensure sustainable solutions to reduce financial barriers to leishmaniasis care, especially in pursuing universal health coverage.

KEYWORDS:

• Economic burden
• cost-of-illness
• direct cost
• indirect cost
• leishmaniasis
• kala-azar

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

T Sunyoto, F Meheus and M Boelaert conceptualized, designed and analyzed the study. T Sunyoto wrote the first draft. F Meheus and M Boelaert contributed in writing and critical revision of the manuscript.

Supplementary Material

Supplemental data can be accessed here.

Additional information

Funding

TS is a member of Euroleish network, a project that has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie International Training Network grant agreement No [642609].