{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T14:02:23Z","timestamp":1764770543867,"version":"3.46.0"},"reference-count":18,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Skin-related neglected tropical diseases (NTDs) represent an emerging public health and economic challenge in India. In the present prospective observational study, out-of-pocket expenditure and catastrophic health expenditure among patients diagnosed with mycetoma, subcutaneous mycoses, leishmaniasis, and cutaneous tuberculosis and nontuberculous mycobacterial (TB-NTM) infections were assessed. Using structured questionnaires, direct and indirect costs were recorded over a 6-month period. Of the 21 patients enrolled (median age 42 years), 42.9% were household heads and 61.9% lived below the international poverty line. The mean direct and indirect medical costs were $171 \u00b1 $113 and $315 \u00b1 $338, respectively, with treatment costs being the major driver of expenditure. Catastrophic health expenditure was observed in 95.2% of patients, and in nearly one-quarter of cases, health expenses exceeded the total family income. Notably, patients with TB-NTM incurred the highest individual expenses (mean $642 \u00b1 $323). The economic fallout was profound: 33.3% of patients lost employment because of disease-related disability. The study findings highlight the urgent need for enhanced public healthcare access, expanded insurance coverage\u2014including outpatient services and essential medications\u2014and targeted social support to reduce the crippling financial burden of skin-related NTDs in vulnerable populations. In addition, the development of standardized, country-specific diagnostic and treatment guidelines is critical for facilitating early diagnosis, timely intervention, and the prevention of disability and impoverishment in affected populations.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0010","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T16:48:11Z","timestamp":1761670091000},"page":"1446-1451","source":"Crossref","is-referenced-by-count":0,"title":["Out-of-Pocket Health Expenditure among Patients with Skin-Related Neglected Tropical Diseases and Cutaneous Tuberculosis in North India"],"prefix":"10.4269","volume":"113","author":[{"given":"P.","family":"Janaani","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charvi","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarun","family":"Narang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Kavita","sequence":"additional","affiliation":[{"name":"National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil","family":"Dogra","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Rev Inst Med Trop Sao Paulo","first-page":"e41","article-title":"Economic evaluations addressing diagnosis and treatment strategies for neglected tropical diseases: An overview","volume":"63","author":"de Assis","year":"2021"},{"key":"b2","series-title":"Biomed Res Int","first-page":"5245021","article-title":"Emerging and neglected infectious diseases: Insights, advances, and challenges","volume":"2017","author":"Nii-Trebi","year":"2017"},{"key":"b3","series-title":"PLoS Negl Trop Dis","first-page":"e1222","article-title":"The neglected tropical diseases of India and South Asia: Review of their prevalence, distribution, and control or elimination","volume":"5","author":"Lobo","year":"2011"},{"key":"b4","series-title":"PLoS Negl Trop Dis","first-page":"e0003527","article-title":"Health economic evaluations of visceral leishmaniasis treatments: A systematic review","volume":"9","author":"Marinho","year":"2015"},{"key":"b5","series-title":"Cost Eff Resour Alloc","first-page":"50","article-title":"Overview of the main methods used for estimating catastrophic health expenditure","volume":"21","author":"Nguyen","year":"2023"},{"key":"b6","series-title":"Indian J Dermatol","first-page":"496","article-title":"Epidemiology of subcutaneous mycoses in northeast India: A retrospective study","volume":"63","author":"Verma","year":"2018"},{"key":"b7","series-title":"Indian Dermatol Online J","first-page":"826","article-title":"Clinical spectrum of cutaneous tuberculosis in central India: A retrospective study","volume":"12","author":"Supekar","year":"2021"},{"key":"b8","series-title":"J Skin Sex Transm Dis","first-page":"90","article-title":"Cutaneous non-tuberculous mycobacterial infections: An update","volume":"5","author":"George","year":"2023"},{"key":"b9","series-title":"Int J Equity Health","first-page":"160","article-title":"Financing care for severe stigmatizing skin diseases (SSSDs) in Liberia: Challenges and opportunities","volume":"21","author":"Smith","year":"2022"},{"key":"b10","series-title":"PLoS Negl Trop Dis","first-page":"e0012086","article-title":"Financial hardship among patients suffering from neglected tropical diseases: A systematic review and meta-analysis of global literature","volume":"18","author":"Patikorn","year":"2024"},{"key":"b11","series-title":"Cad Saude Publica","first-page":"e00136419","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":"Galv\u00e3o","year":"2020"},{"key":"b12","series-title":"Rev Econ Del Caribe","first-page":"52","article-title":"Economic evaluations in cutaneous leishmaniasis: A systematic review of literature 1980-2015","volume":"20","author":"Cardona-Arias","year":"2017"},{"key":"b13","series-title":"Biomed Res Int","first-page":"3025185","article-title":"The economic impact of cutaneous leishmaniasis in Sri Lanka","volume":"2018","author":"Wijerathna","year":"2018"},{"key":"b14","series-title":"Trop Med Int Health","first-page":"803","article-title":"Direct and indirect patient costs of tuberculosis care in India","volume":"25","author":"Chandra","year":"2020"},{"key":"b15","series-title":"PLoS Negl Trop Dis","first-page":"e0006052","article-title":"Drug resistance and treatment failure in leishmaniasis: A 21st century challenge","volume":"11","author":"Ponte-Sucre","year":"2017"},{"key":"b16","series-title":"CSDM","first-page":"8","article-title":"Cutaneous leishmaniasis in India","volume":"4","author":"Thappa","year":"2024"},{"key":"b17","series-title":"Trop Med Int Health","first-page":"1715","article-title":"Costs of patient management of visceral leishmaniasis in Muzaffarpur, Bihar, India","volume":"11","author":"Meheus","year":"2006"},{"key":"b18","series-title":"Health Policy Plan","first-page":"926","article-title":"A comprehensive examination of the economic impact of out-of-pocket health expenditures in India","volume":"38","author":"Nanda","year":"2023"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/6\/article-p1446.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/6\/article-p1446.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/6\/article-p1446.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T13:32:58Z","timestamp":1764768778000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/6\/article-p1446.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,3]]},"references-count":18,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0010","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"type":"print","value":"0002-9637"},{"type":"electronic","value":"1476-1645"}],"subject":[],"published":{"date-parts":[[2025,12,3]]}}}