{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:20:36Z","timestamp":1787822436637,"version":"build-2784847793"},"reference-count":17,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Leprosy continues to impose a significant clinical and socioeconomic burden. Despite free multidrug therapy, patients incur substantial out-of-pocket expenditure (OOPE), leading to catastrophic health expenditure (CHE). Evidence on the economic burden of leprosy in India remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A pilot prospective observational study was conducted at a tertiary care center in North India, enrolling 56 patients with leprosy. Data on sociodemographic characteristics, direct and indirect healthcare costs, and income were collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study population had a median age of 30 years, with 73% males, and 68% from rural areas. Multibacillary disease predominated (93%), with complications in 73.2% and a median diagnostic delay of 24 months. Median monthly household income was Indian Rupees (\u20b9)12 000, while median OOPE was \u20b91625, largely driven by medicines and travel. CHE was observed in 55.4% of patients. OOPE was significantly higher in multibacillary cases compared with paucibacillary disease (P = .04). A considerable proportion of patients resorted to borrowing money, indicating financial distress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Leprosy imposes a substantial financial burden, with more than one-half of patients experiencing CHE. Strengthening early diagnosis, decentralizing care, and improving financial protection mechanisms are essential to mitigate economic hardship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/trstmh\/trag094","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:53:55Z","timestamp":1785412435000},"source":"Crossref","is-referenced-by-count":0,"title":["Out-of-pocket expenditure and catastrophic health expenditure in patients of leprosy at a tertiary care center in India"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2440-9460","authenticated-orcid":false,"given":"Kavita","family":"Kavita","sequence":"first","affiliation":[{"name":"National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research , Sector 12, Madhya Marg, Chandigarh \u2013 160012 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2526-4494","authenticated-orcid":false,"given":"Sukhdeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venerology and Leprology, Postgraduate Institute of Medical Education and Research , Sector 12, Madhya Marg, Chandigarh-160012 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9589-0308","authenticated-orcid":false,"given":"Kittu","family":"Malhi","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venerology and Leprology, Postgraduate Institute of Medical Education and Research , Sector 12, Madhya Marg, Chandigarh-160012 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manisha","family":"Upreti","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venerology and Leprology, Postgraduate Institute of Medical Education and Research , Sector 12, Madhya Marg, Chandigarh-160012 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushma","family":"Saini","sequence":"additional","affiliation":[{"name":"National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research , Sector 12, Madhya Marg, Chandigarh \u2013 160012 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arushi","family":"Ghai","sequence":"additional","affiliation":[{"name":"South Asia Field Epidemiology and Technology Network (SAFETYNET), Epidemiology division, National Centre for Disease Control , 22, Shamnath Marg, New Delhi-110054 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritin","family":"Mohindra","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Postgraduate Institute of Medical Education and Research , Sector 12, Madhya Marg, Chandigarh-160012 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0464-2989","authenticated-orcid":false,"given":"Tarun","family":"Narang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venerology and Leprology, Postgraduate Institute of Medical Education and Research , Sector 12, Madhya Marg, Chandigarh-160012 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9912-0085","authenticated-orcid":false,"given":"Sunil","family":"Dogra","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venerology and Leprology, Postgraduate Institute of Medical Education and Research , Sector 12, Madhya Marg, Chandigarh-160012 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"2026082704425851200_bib1","doi-asserted-by":"crossref","first-page":"121","DOI":"10.47276\/lr.83.2.121","article-title":"The importance of neglected tropical diseases in sustaining leprosy programmes","volume":"83","author":"Smith","year":"2012","journal-title":"Lepr Rev"},{"key":"2026082704425851200_bib2","doi-asserted-by":"crossref","first-page":"e2024067","DOI":"10.47276\/lr.95.4.2024067","article-title":"Secular trends in leprosy burden: comparative insights from India and Brazil in the last three decades using the Global Burden of Disease study data","volume":"95","author":"Shalini","year":"2024","journal-title":"Lepr Rev"},{"key":"2026082704425851200_bib3","first-page":"501","article-title":"Global leprosy (Hansen disease) update, 2023: elimination of leprosy disease is possible\u2014Time to act","volume":"99","author":"World Health Organization","year":"2024","journal-title":"Wkly Epidemiol Rec"},{"key":"2026082704425851200_bib4","author":"Ministry of Health and Family Welfare","year":"2023","journal-title":"National Strategic Plan and Roadmap for Leprosy (2023\u20132027)"},{"key":"2026082704425851200_bib5","article-title":"Towards zero leprosy","volume-title":"Global Leprosy (Hansen\u2019s Disease) Strategy 2021-2030","author":"World Health Organization","year":"2021"},{"key":"2026082704425851200_bib6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.25259\/IJMR_2212_2024","article-title":"Beating leprosy: unmasking challenges, ending stigma, & prioritizing mental well-being","volume":"161","author":"Singh","year":"2025","journal-title":"Indian J Med Res"},{"key":"2026082704425851200_bib7","doi-asserted-by":"crossref","first-page":"20503121241281424","DOI":"10.1177\/20503121241281424","article-title":"The economic burden of leprosy treatment to households in Ghana: a cross-sectional study in the Volta Region of Ghana","volume":"12","author":"Dalaba","year":"2024","journal-title":"SAGE Open Med"},{"key":"2026082704425851200_bib8","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1038\/s41572-024-00575-1","article-title":"Leprosy","volume":"10","author":"Grijsen","year":"2024","journal-title":"Nat Rev Dis Primers"},{"key":"2026082704425851200_bib9","doi-asserted-by":"crossref","first-page":"e0003431","DOI":"10.1371\/journal.pntd.0003431","article-title":"Household costs of leprosy reactions (ENL) in rural India","volume":"9","author":"Chandler","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"2026082704425851200_bib10","doi-asserted-by":"crossref","first-page":"e0006181","DOI":"10.1371\/journal.pntd.0006181","article-title":"Household expenditure on leprosy outpatient services in the Indian health system: a comparative study","volume":"12","author":"Tiwari","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"2026082704425851200_bib11","doi-asserted-by":"crossref","first-page":"e0196106","DOI":"10.1371\/journal.pone.0196106","article-title":"Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: do Indian households face distress health financing?","volume":"13","author":"Kastor","year":"2018","journal-title":"PLoS One"},{"key":"2026082704425851200_bib12","doi-asserted-by":"crossref","first-page":"18","DOI":"10.2471\/BLT.17.191759","article-title":"Trends in catastrophic health expenditure in India: 1993 to 2014","volume":"96","author":"Pandey","year":"2018","journal-title":"Bull World Health Organ"},{"key":"2026082704425851200_bib13","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s12962-023-00457-5","article-title":"Overview of the main methods used for estimating catastrophic health expenditure","volume":"21","author":"Nguyen","year":"2023","journal-title":"Cost Eff Resour Alloc"},{"key":"2026082704425851200_bib14","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1001\/jamadermatol.2019.1768","article-title":"Risk factors for physical disability in patients with leprosy: a systematic review and meta-analysis","volume":"155","author":"de\u00a0Paula","year":"2019","journal-title":"JAMA Dermatol"},{"key":"2026082704425851200_bib15","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/tmi.13182","article-title":"Leprosy services in primary health care in India: comparative economic cost analysis of two public-health settings","volume":"24","author":"Tiwari","year":"2019","journal-title":"Trop Med Int Health"},{"key":"2026082704425851200_bib16","volume-title":"Financial services","author":"The Leprosy Mission Trust India"},{"key":"2026082704425851200_bib17","article-title":"Maintenance Allowance for Leprosy Affected Persons (MAFLAP)","author":"Government of India"}],"container-title":["Transactions of The Royal Society of Tropical Medicine and Hygiene"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/trstmh\/advance-article-pdf\/doi\/10.1093\/trstmh\/trag094\/70817657\/trag094.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/trstmh\/advance-article-pdf\/doi\/10.1093\/trstmh\/trag094\/70817657\/trag094.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T08:43:04Z","timestamp":1787820184000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/trstmh\/advance-article\/doi\/10.1093\/trstmh\/trag094\/8771658"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":17,"URL":"https:\/\/doi.org\/10.1093\/trstmh\/trag094","relation":{},"ISSN":["0035-9203","1878-3503"],"issn-type":[{"value":"0035-9203","type":"print"},{"value":"1878-3503","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]},"article-number":"trag094"}}