title: Financial burden of health care for Buruli ulcer patients in Nigeria: the patients' perspective.
abstract: The economic burden of Buruli ulcer for patients has not been well-documented. This study assessed the costs of Buruli ulcer care to patients from the onset of illness to diagnosis and to the end of treatment.
  
  
  
  This was a cross-sectional cost of illness study conducted among patients with Buruli ulcer in four States in Nigeria between July and September 2015. A structured questionnaire was used to collect data on the patients' characteristics, household income and out-of-pocket costs of care.
  
  
  
  Of 92 patients surveyed, 54 (59%) were older than 15years, 49 (53%) were males, and 86 (93%) resided in a rural area. The median (IQR) direct medical and non-medical cost per patient was US$124 (50-282) and US$3 (3-6); corresponding to 149% and 4% of the patients' median monthly household income, respectively. The overall direct costs per patient was US$135 (58-327), which corresponded to 162% of median monthly household income, with pre-diagnosis costs accounting for 94.8% of the total costs. The direct costs of Buruli ulcer care were catastrophic for 50% of all patients/households - the rates of catastrophic costs for Buruli ulcer care was 66% and 19% for patients belonging to the lowest and highest income quartiles, respectively.
  
  
  
  Direct costs of Buruli ulcer diagnosis and treatment are catastrophic to a substantial proportion of patients and their families.
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Chukwu
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Meka
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Nwafor
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Oshi
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors.forename: Nelson O
authors.initials: NO
authors.lastname: Madichie
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors.forename: Ngozi
authors.initials: N
authors.lastname: Ekeke
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors.forename: Moses C
authors.initials: MC
authors.lastname: Anyim
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors.forename: Alphonsus
authors.initials: A
authors.lastname: Chukwuka
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors.forename: Mbah
authors.initials: M
authors.lastname: Obinna
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
authors.forename: Julie
authors.initials: J
authors.lastname: Adegbesan
authors.affiliation: St Benedict's Tuberculosis & Leprosy Rehabilitation Hospital, Ogoja, Cross River State, Nigeria.
authors.forename: Martin
authors.initials: M
authors.lastname: Njoku
authors.affiliation: Ogun State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Ogun State, Nigeria.
authors.forename: Festus O
authors.initials: FO
authors.lastname: Soyinka
authors.affiliation: Ogun State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Ogun State, Nigeria.
authors.forename: Adebola O
authors.initials: AO
authors.lastname: Adelokiki
authors.affiliation: Anambra State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Anambra State, Nigeria.
authors.forename: Isreal O
authors.initials: IO
authors.lastname: Enemuoh
authors.affiliation: Anambra State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Anambra State, Nigeria.
authors.forename: Patrick I
authors.initials: PI
authors.lastname: Okolie
authors.affiliation: Anambra State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Anambra State, Nigeria.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Edochie
authors.affiliation: Cross River State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Cross River State, Nigeria.
authors.forename: Jonah B
authors.initials: JB
authors.lastname: Offor
authors.affiliation: Cross River State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Cross River State, Nigeria.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ushaka
authors.affiliation: Department of Medicine, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria ukwajakingsley@yahoo.co.uk.
authors.forename: Kingsley N
authors.initials: KN
authors.lastname: Ukwaja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054312:Buruli Ulcer / Q000191:economics* / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Buruli ulcer; Cost of illness; Health economics; Illness costs; Mycobacterium ulcerans; Nigeria