{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T13:30:49Z","timestamp":1769088649745,"version":"3.49.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0013020","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000}}],"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006507","name":"Funda\u00e7\u00e3o Oswaldo Cruz","doi-asserted-by":"publisher","award":["VPPCB-008-FIO-18-2-80 - Programa Inova Fiocruz"],"award-info":[{"award-number":["VPPCB-008-FIO-18-2-80 - Programa Inova Fiocruz"]}],"id":[{"id":"10.13039\/501100006507","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["CNPq 302069\/2022-4"],"award-info":[{"award-number":["CNPq 302069\/2022-4"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec007\">\n<jats:title>Background<\/jats:title>\n<jats:p>Healthcare expenses represent a proportionally greater burden for the poorest populations, which further exacerbates the negative impact of the disease on the individual\u2019s quality of life and productivity.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec008\">\n<jats:title>Objective<\/jats:title>\n<jats:p>The study aimed to identify the direct and indirect costs during the treatment of cutaneous leishmaniasis (CL) from the patients\u2019 perspective and examine factors influencing the costs burden among CL patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec009\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A prospective cost analysis was conducted between April 2022 and April 2023 through interviews with patients with a confirmed diagnosis of CL. Direct costs were estimated using the micro-costing approach, and indirect costs using the human capital method. Descriptive analyses and hypothesis tests were conducted for associations between costs and sociodemographic and clinical variables, with a significance level of 5%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec010\">\n<jats:title>Results<\/jats:title>\n<jats:p>The study included 68 patients, predominantly male (77.9%) with an average age of 53 years. Cutaneous leishmaniasis was the most common clinical form (76.4%), with new cases accounting for 79.4% of participants. Patients averaged 3.5 outpatient visits per CL treatment cycle, with miltefosine and intravenous meglumine antimoniate being the most prescribed therapies. Direct costs per treatment cycle averaged USD 117.36, attributed to transportation, food, and medical exams. Indirect costs from lost workdays amounted to USD 9,936.58, with an average of USD 160.12 per patient. Catastrophic expenditure (&gt;10% of monthly income) was observed in 42.6% of families, significantly associated with direct cost, bacterial infection, and sociodemographic factors such as gender, age, and distance traveled.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec011\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study underscores the substantial economic burden of CL treatment on patients, highlighting the need for targeted interventions to mitigate financial hardship, particularly among vulnerable socioeconomic groups.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0013020","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T17:34:27Z","timestamp":1744738467000},"page":"e0013020","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["The burden of out-of-pocket and indirect costs of cutaneous leishmaniasis patients in Minas Gerais, Brazil"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1087-9819","authenticated-orcid":true,"given":"Sarah Nascimento","family":"Silva","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Endi Lanza","family":"Galv\u00e3o","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jana\u00edna de Pina","family":"Carvalho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mayra Soares","family":"Moreira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T\u00e1lia Santana","family":"Machado de Assis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glaucia","family":"Cota","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"pntd.0013020.ref001","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.micinf.2014.07.006","article-title":"Brazil\u2019s neglected tropical diseases: an overview and a report card","volume":"16","author":"PJ Hotez","year":"2014","journal-title":"Microbes Infect"},{"key":"pntd.0013020.ref002","author":"World Bank","year":"2019"},{"key":"pntd.0013020.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.26633\/RPSP.2023.146","article-title":"Mortalidade por doen\u00e7as tropicais negligenciadas no Brasil no s\u00e9culo XXI: an\u00e1lise de tend\u00eancias espaciais e temporais e fatores associados","volume":"47","author":"MIF Rocha","year":"2023","journal-title":"Revista Panamericana de Salud P\u00fablica"},{"key":"pntd.0013020.ref004","doi-asserted-by":"crossref","first-page":"e102","DOI":"10.1371\/journal.pmed.0030102","article-title":"Incorporating a rapid-impact package for neglected tropical diseases with programs for HIV\/AIDS, tuberculosis, and malaria: a comprehensive pro-poor health policy and strategy for the developing world","volume":"3","author":"PJ Hotez","year":"2006","journal-title":"PLoS Med"},{"key":"pntd.0013020.ref005","volume-title":"Doen\u00e7as negligenciadas no Brasil: vulnerabilidade e desafios","author":"Brasil. Minist\u00e9rio da Sa\u00fade","year":"2018"},{"key":"pntd.0013020.ref006","volume-title":"Secretaria de Vigil\u00e2ncia em Sa\u00fade. Manual de vigil\u00e2ncia da leishmaniose tegumentar","author":"Brasil. Minist\u00e9rio da Sa\u00fade","year":"2017"},{"key":"pntd.0013020.ref007","volume-title":"DIRETRIZ METODOL\u00d3GICA: Estudos de Microcusteio Aplicados a Avalia\u00e7\u00e3o Econ\u00f4mica em Sa\u00fade","author":"Brasil. Minist\u00e9rio da Sa\u00fade","year":"2020"},{"key":"pntd.0013020.ref008","author":"LP Garcia","year":"2011"},{"key":"pntd.0013020.ref009","article-title":"Identifica\u00e7\u00e3o, mensura\u00e7\u00e3o e valora\u00e7\u00e3o de custos em sa\u00fade","volume":"25","author":"da Silva EN","year":"2016","journal-title":"Epidemiologia e Servi\u00e7os de Sa\u00fade"},{"key":"pntd.0013020.ref010","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1111\/tmi.12994","article-title":"Cost of visceral leishmaniasis care in Brazil","volume":"22","author":"IPSF de Carvalho","year":"2017","journal-title":"Trop Med Int Health"},{"key":"pntd.0013020.ref011","article-title":"Estimating direct costs of the treatment for mucosal leishmaniasis in Brazil","volume":"54","author":"J de P Carvalho","year":"2021","journal-title":"Rev Soc Bras Med Trop"},{"key":"pntd.0013020.ref012","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1590\/0037-8682-0133-2017","article-title":"The direct costs of treating human visceral leishmaniasis in Brazil","volume":"50","author":"de Assis TSM","year":"2017","journal-title":"Rev Soc Bras Med Trop"},{"key":"pntd.0013020.ref013","doi-asserted-by":"crossref","first-page":"e1957537","DOI":"10.1080\/23288604.2021.1957537","article-title":"Measuring Financial Protection in Health in Brazil: Catastrophic and Poverty Impacts of Health Care Payments Using the Latest National Household Consumption Survey","volume":"7","author":"EC Araujo","year":"2021","journal-title":"Health Syst Reform"},{"key":"pntd.0013020.ref014","unstructured":"Organization WH. Financing of health care from households\u2019 out-of-pocket payments, voluntary payment schemes and external resources. 2020."},{"key":"pntd.0013020.ref015","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s12962-021-00301-8","article-title":"Strategies for reducing out of pocket payments in the health system: a scoping review","volume":"19","author":"FS Jalali","year":"2021","journal-title":"Cost Eff Resour Alloc"},{"key":"pntd.0013020.ref016","author":"WHO","year":"2024"},{"key":"pntd.0013020.ref017","article-title":"Conta-Sat\u00e9lite de Sa\u00fade 2010-2019.","volume-title":"Contas Nacionais n. 87","author":"IBGE","year":"2022"},{"key":"pntd.0013020.ref018","doi-asserted-by":"crossref","first-page":"e00136419","DOI":"10.1590\/0102-311x00136419","article-title":"Economic impact of localized cutaneous leishmaniasis on adult patients of a referral service in Belo Horizonte, Minas Gerais State, Brazil","volume":"36","author":"EL Galv\u00e3o","year":"2020","journal-title":"Cad Saude Publica"},{"key":"pntd.0013020.ref019","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1590\/1413-81232022271.40442020","article-title":"Gastos catastr\u00f3ficos em sa\u00fade: an\u00e1lise da associa\u00e7\u00e3o com condi\u00e7\u00f5es socioecon\u00f4micas em Minas Gerais, Brasil","volume":"27","author":"J de B Macedo","year":"2022","journal-title":"Cien Saude Colet"},{"key":"pntd.0013020.ref020","unstructured":"Presidencia da Rep\u00fablica do Brasil. Lei 12.401 de 28 de abril de 2011. Diario Oficial da Uni\u00e3o. 2011;12401."},{"key":"pntd.0013020.ref021","doi-asserted-by":"crossref","first-page":"2475","DOI":"10.1590\/1413-81232017228.10952017","article-title":"Avalia\u00e7\u00e3o da infraestrutura da assist\u00eancia farmac\u00eautica no sistema \u00fanico de sa\u00fade em Minas Gerais","volume":"22","author":"MM Barbosa","year":"2017","journal-title":"Cien Saude Colet"},{"key":"pntd.0013020.ref022","first-page":"51","article-title":"A Regionaliza\u00e7\u00e3o da Assist\u00eancia Farmac\u00eautica de Minas Gerais E a Estrat\u00e9gia Log\u00edstica de Descentraliza\u00e7\u00e3o da Aquisi\u00e7\u00e3o de Medicamentos B\u00e1sicos Para O Sus.","volume":"7","author":"CC Carlo","year":"2019","journal-title":"Revista Economia e Pol\u00edticas P\u00fablicas"},{"key":"pntd.0013020.ref023","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/j.jval.2016.05.010","article-title":"A systematic review of health economic evaluation studies using the patient\u2019s perspective","volume":"19","author":"B-WB Tai","year":"2016","journal-title":"Value in Health"},{"key":"pntd.0013020.ref024","first-page":"e20","article-title":"Determinantes del gasto de bolsillo en salud de la poblaci\u00f3n pobre atendida en servicios de salud p\u00fablicos en Per\u00fa, 2010\u20132014","volume":"42","author":"MP Pavone","year":"2018","journal-title":"Revista Panamericana de Salud P\u00fablica"},{"key":"pntd.0013020.ref025","doi-asserted-by":"crossref","first-page":"106963","DOI":"10.1016\/j.actatropica.2023.106963","article-title":"Analysis of the costs incurred by patients with Chagas disease: The experience in endemic municipalities in Colombia","volume":"245","author":"R Herazo","year":"2023","journal-title":"Acta Trop"},{"key":"pntd.0013020.ref026","first-page":"135","article-title":"Vulnerabilities to and the Socioeconomic and Psychosocial Impacts of the Leishmaniases: A Review","volume":"12","author":"G Grifferty","year":"2021","journal-title":"Res Rep Trop Med"},{"key":"pntd.0013020.ref027","doi-asserted-by":"crossref","first-page":"3025185","DOI":"10.1155\/2018\/3025185","article-title":"The economic impact of cutaneous leishmaniasis in Sri Lanka","volume":"2018","author":"T Wijerathna","year":"2018","journal-title":"Biomed Res Int"},{"key":"pntd.0013020.ref028","doi-asserted-by":"crossref","first-page":"e0007996","DOI":"10.1371\/journal.pntd.0007996","article-title":"Patients\u2019 preferences of cutaneous leishmaniasis treatment outcomes: Findings from an international qualitative study","volume":"14","author":"AC Erber","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0013020.ref029","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1590\/0103-110420151070397","article-title":"Planejamento regional compartilhado em Minas Gerais: avan\u00e7os e desafios","volume":"39","author":"N Bretas Junior","year":"2015","journal-title":"Sa\u00fade em Debate"},{"key":"pntd.0013020.ref030","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12962-021-00301-8","article-title":"Strategies for reducing out of pocket payments in the health system: a scoping review","volume":"19","author":"FS Jalali","year":"2021","journal-title":"Cost Eff Resour Alloc"},{"issue":"1","key":"pntd.0013020.ref031","doi-asserted-by":"crossref","first-page":"e0002872","DOI":"10.1371\/journal.pgph.0002872","article-title":"Modeling the global impact of reducing out-of-pocket costs for children\u2019s surgical care","volume":"4","author":"ER Smith","year":"2024","journal-title":"PLOS Glob Public Health"},{"key":"pntd.0013020.ref032","doi-asserted-by":"crossref","first-page":"e069572","DOI":"10.1136\/bmjopen-2022-069572","article-title":"Does reducing out-of-pocket costs for children\u2019s surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study","volume":"13","author":"ER Smith","year":"2023","journal-title":"BMJ Open"},{"key":"pntd.0013020.ref033","doi-asserted-by":"crossref","first-page":"S38","DOI":"10.1016\/S2214-109X(15)70085-9","article-title":"Catastrophic expenditure to pay for surgery worldwide: a modelling study","volume":"3","author":"MG Shrime","year":"2015","journal-title":"Lancet Glob Health"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0013020","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0013020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T20:05:47Z","timestamp":1746475547000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0013020"}},"subtitle":[],"editor":[{"given":"Helen P","family":"Price","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,15]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0013020","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0013020","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,15]]}}}