{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:43:05Z","timestamp":1774532585139,"version":"3.50.1"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR200132"],"award-info":[{"award-number":["NIHR200132"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR200132"],"award-info":[{"award-number":["NIHR200132"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR200132"],"award-info":[{"award-number":["NIHR200132"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR200132"],"award-info":[{"award-number":["NIHR200132"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR200132"],"award-info":[{"award-number":["NIHR200132"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR200132"],"award-info":[{"award-number":["NIHR200132"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR200132"],"award-info":[{"award-number":["NIHR200132"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Leprosy is a curable disease, treated by multidrug therapy. However, patients are often left with neuropathic damage leading to lifelong vulnerability to ulcers. Quantifying the value of interventions to improve ulcer healing is challenging as data on the health impact of plantar ulcers are scarce, especially in low- and middle-income countries. We aim to quantify the impact of plantar ulcers on patients\u2019 health-related quality of life (HRQoL) using methods which can inform decisions about the effectiveness and cost-effectiveness of alternative forms of management.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Generic HRQoL data were collected using the EuroQol (EQ)-5D-3L questionnaire in a randomised control trial in Nepal, treating plantar ulcers with leukocyte and platelet-rich fibrin or usual care. The trial followed 130 patients resulting in 600 observations. EQ-5D data were converted into a single \u2018utility\u2019 score by weighting the instrument\u2019s different dimensions using the preferences of the Sri Lankan population. Utility data were analysed using general estimating equation regressions. The impact of an ulcer on HRQoL was estimated whilst controlling for clinical and demographic covariables.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Estimated mean utility (standard error) for the sample across all time points was 0.52 (0.02) for patients with an ulcer and 0.64 (0.01) with a healed ulcer. Controlling for clinical and demographic covariates, we estimate that the presence of an ulcer leads to a 0.12 (0.02) decrement in HRQoL compared with a healed ulcer.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>Based on the levels of health they report and the values of the general public, patients with a history of leprosy are at risk of significant HRQoL burden from neuropathic plantar ulcers. Quantifying this health impact provides important evidence to assess the effectiveness and cost-effectiveness of leprosy ulcer interventions and ensures that interventions for leprosy ulcers can be appropriately considered for funding under Universal Health Coverage against other potential uses of the same money.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0315944","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T18:23:19Z","timestamp":1739298199000},"page":"e0315944","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Health-related quality of life implications of plantar ulcers resulting from neuropathic damage caused by leprosy: An analysis from the trial of autologous blood products (TABLE trial) in Nepal"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4704-8082","authenticated-orcid":true,"given":"Naomi Kate","family":"Gibbs","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Ochalek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Indra Bahadur","family":"Napit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6234-4288","authenticated-orcid":true,"given":"Dilip","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro Saramago","family":"Goncalves","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard J.","family":"Lilford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Sculpher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"issue":"6","key":"pone.0315944.ref001","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/S1473-3099(11)70006-8","article-title":"Leprosy now: epidemiology, progress, challenges, and research gaps","volume":"11","author":"LC Rodrigues","year":"2011","journal-title":"The Lancet infectious diseases"},{"issue":"3","key":"pone.0315944.ref002","doi-asserted-by":"crossref","first-page":"e0006317","DOI":"10.1371\/journal.pntd.0006317","article-title":"Dietary diversity and poverty as risk factors for leprosy in Indonesia: A case-control study","volume":"12","author":"S Oktaria","year":"2018","journal-title":"PLOS Neglected Tropical Diseases"},{"issue":"9","key":"pone.0315944.ref003","doi-asserted-by":"crossref","first-page":"e1226","DOI":"10.1016\/S2214-109X(19)30260-8","article-title":"Socioeconomic determinants of leprosy new case detection in the 100 Million Brazilian Cohort: a population-based linkage study","volume":"7","author":"JS Nery","year":"2019","journal-title":"The Lancet Global Health"},{"issue":"4","key":"pone.0315944.ref004","first-page":"492","article-title":"Leprosy: between acceptance and segregation. Community behaviour towards persons affected by leprosy in eastern Nepal","volume":"71","author":"D De Stigter","year":"2000","journal-title":"Leprosy review"},{"key":"pone.0315944.ref005","first-page":"94","article-title":"Global leprosy update, 2018: moving towards a leprosy free world","author":"WH Organization","year":"2019","journal-title":"Weekly Epidemiological Record"},{"key":"pone.0315944.ref006","unstructured":"Organization WH. Towards zero leprosy: global Leprosy (Hansen\u2019s disease) Strategy 2021\u20132030: World Health Organization; 2021."},{"key":"pone.0315944.ref007","unstructured":"International TLM. 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