{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T07:15:48Z","timestamp":1782976548331,"version":"3.54.5"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Scabies is one of the common infectious skin conditions globally, with a significantly high burden in hot and tropical countries, and resource-poor settings. Rohingya refugee camps in Cox\u2019s Bazar are one of the most protracted refugee crises in the world, sheltering approximately 1,143,096 refugees. While most existing literature focuses on mass drug administration (MDA) interventions or community-level estimates, the economic burden of scabies on health system is rarely studied. This is a retrospective costing study, where we used financial and epidemiological data from January 2021 to December 2024. Costing was done from the provider's perspective, focused on what International Organization for Migration (IOM) spent during the period as a health service provider. A combination of standard stepdown approach and micro-costing methods were used. Financial data were collected from the IOM health programme\u2019s annual budget and consumption reports. The study population included all individuals who were clinically diagnosed with scabies and received care at 35 IOM-supported health facilities in Cox\u2019s Bazar, Bangladesh. The overall estimated financial cost for IOM\u2019s scabies outbreak response was USD 2.12 million, with an annual average of USD 531,729. The average cost per scabies management ranged between USD 5.33 and USD 6.54. Drug costs accounted for 11.92% of the overall cost over 4 years. Of the total cost of USD 253,629.43 over 4 years, 79% was attributed to permethrin topical cream, which was used to manage an estimated 85% of the total managed cases. Scenario analyses demonstrates that the existing permethrin-based treatment preference is the most expensive treatment modality, compared with ivermectin-based treatment and mixed-treatment approaches. Although the average cost of treating scabies is relatively low, overall, the treatment cost for such a large population has a significant economic impact. This study found a substantial effect of MDA on reducing the financial burden on the healthcare system.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005772","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T17:54:33Z","timestamp":1775238873000},"page":"e0005772","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Economic impact of a large-scale scabies upsurge on healthcare facilities in Rohingya refugee camps: A retrospective costing study"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4862-7745","authenticated-orcid":true,"given":"Charls Erik","family":"Halder","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9205-7810","authenticated-orcid":true,"given":"Md Abeed","family":"Hasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James Charles","family":"Okello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayed Sunny","family":"Uz Zaman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julekha Tabassum","family":"Poly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0719-9908","authenticated-orcid":true,"given":"Hamim","family":"Tassdik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9700-4847","authenticated-orcid":true,"given":"Dickson Wafula","family":"Barasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel Roba","family":"Soma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Farhad","family":"Hussain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U Maung","family":"Prue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirajul Munir","family":"Khandokar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Patrick","family":"Almedia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0389-2969","authenticated-orcid":true,"given":"Jahangir","family":"Alam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"pgph.0005772.ref001","unstructured":"World Health Organization. Scabies. WHO. Accessed 2025 July 26. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/scabies"},{"issue":"2","key":"pgph.0005772.ref002","doi-asserted-by":"crossref","first-page":"77","DOI":"10.4274\/tpd.galenos.2020.6796","article-title":"Epidemiological evaluation of scabies cases encountered in the last three years as a tertiary health center","volume":"44","author":"\u00c7 Turan","year":"2020","journal-title":"Turkiye Parazitol Derg"},{"issue":"12","key":"pgph.0005772.ref003","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1016\/S1473-3099(17)30483-8","article-title":"The global burden of scabies: a cross-sectional analysis from the Global Burden of Disease Study 2015","volume":"17","author":"C Karimkhani","year":"2017","journal-title":"Lancet Infect Dis"},{"issue":"10","key":"pgph.0005772.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0003706","article-title":"Costs of primary healthcare presentations and hospital admissions for scabies and related skin infections in Fiji, 2018\u20132019","volume":"4","author":"E Akpan","year":"2024","journal-title":"PLOS Glob Public Health"},{"key":"pgph.0005772.ref005","unstructured":"United Nations High Commissioner for Refugees UNHCR. Country \u2013 Bangladesh. Accessed 2025 July 26. https:\/\/data.unhcr.org\/en\/country\/bgd"},{"key":"pgph.0005772.ref006","unstructured":"World Health Organization. WHO implements large-scale ivermectin-based MDA for one million Rohingya refugees. 2024. Accessed 2025 July 26. https:\/\/www.who.int\/bangladesh\/news\/detail\/29-01-2024-who-implements-large-scale-ivermectin-based-mda-for-one-million-rohingya-refugees"},{"key":"pgph.0005772.ref007","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/S0190-9622(00)90131-2","article-title":"A comparative study of oral ivermectin and topical permethrin cream in the treatment of scabies","volume":"42","author":"V Usha","year":"2000","journal-title":"J Am Acad Dermatol"},{"key":"pgph.0005772.ref008","doi-asserted-by":"crossref","first-page":"28","DOI":"10.12703\/r\/10-28","article-title":"Recent advances in understanding and treating scabies","volume":"10","author":"E Welch","year":"2021","journal-title":"Fac Rev"},{"issue":"2","key":"pgph.0005772.ref009","article-title":"Costs of mass drug administration for scabies in Fiji","volume":"16","author":"M Mow","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"key":"pgph.0005772.ref010","volume-title":"Cost analysis in primary health care: a training manual for programme managers","author":"A Creese","year":"2025"},{"key":"pgph.0005772.ref011","unstructured":"UNAIDS. Costing guidelines for HIV prevention strategies. Accessed 2025 July 26. https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/jc412-costguidel_en_2.pdf"},{"issue":"1","key":"pgph.0005772.ref012","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13561-020-00298-5","article-title":"Micro-costing in health and medicine: a critical appraisal","volume":"11","author":"X Xu","year":"2021","journal-title":"Health Econ Rev"},{"key":"pgph.0005772.ref013","unstructured":"M\u00e9decins Sans Fronti\u00e8res. Clinical guidelines: diagnosis and treatment manual. 2016. Accessed 2025 July 26. https:\/\/medicalguidelines.msf.org\/en\/viewport\/CG\/english\/clinical-guidelines-16686604.html"},{"issue":"8","key":"pgph.0005772.ref014","article-title":"On discount rates for economic evaluations in global health","volume":"34","author":"M Haacker","year":"2019","journal-title":"Health Policy Plan"},{"key":"pgph.0005772.ref015","doi-asserted-by":"crossref","unstructured":"Ashvinbhai PK. 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Accessed 2025 July 26. https:\/\/www.who.int\/health-topics\/neglected-tropical-diseases"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005772","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T17:54:38Z","timestamp":1775238878000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005772"}},"subtitle":[],"editor":[{"given":"Claire J","family":"Standley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,3]]},"references-count":20,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0005772","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,3]]}}}