Out-of-Pocket Health Expenditure among Patients with Skin-Related Neglected Tropical Diseases and Cutaneous Tuberculosis in North India

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 ± $113 and $315 ± $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 ± $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-including outpatient services and essential medications-and 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.