title: Household cost-of-illness of visceral leishmaniasis in Bihar, India.
abstract: OBJECTIVE
  To determine the cost of kala-azar (KA) to patients in Bihar, India.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Banaras Hindu University, Varanasi, India. drshyamsundar@hotmail.com
authors.forename: Shyam
authors.initials: S
authors.lastname: Sundar
authors.forename: Rakesh
authors.initials: R
authors.lastname: Arora
authors.forename: S P
authors.initials: SP
authors.lastname: Singh
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
authors.forename: Beena
authors.initials: B
authors.lastname: Varghese
mesh_terms: D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007194:India; D007898:Leishmaniasis, Visceral / Q000191:economics* / Q000628:therapy; D008297:Male; D018582:Sick Leave; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult