Financial burden of health care for Buruli ulcer patients in Nigeria: the patients' perspective

Int Health. 2017 Jan;9(1):36-43. doi: 10.1093/inthealth/ihw056. Epub 2016 Dec 15.


Background: The economic burden of Buruli ulcer for patients has not been well-documented. This study assessed the costs of Buruli ulcer care to patients from the onset of illness to diagnosis and to the end of treatment.

Methods: This was a cross-sectional cost of illness study conducted among patients with Buruli ulcer in four States in Nigeria between July and September 2015. A structured questionnaire was used to collect data on the patients' characteristics, household income and out-of-pocket costs of care.

Results: Of 92 patients surveyed, 54 (59%) were older than 15years, 49 (53%) were males, and 86 (93%) resided in a rural area. The median (IQR) direct medical and non-medical cost per patient was US$124 (50-282) and US$3 (3-6); corresponding to 149% and 4% of the patients' median monthly household income, respectively. The overall direct costs per patient was US$135 (58-327), which corresponded to 162% of median monthly household income, with pre-diagnosis costs accounting for 94.8% of the total costs. The direct costs of Buruli ulcer care were catastrophic for 50% of all patients/households - the rates of catastrophic costs for Buruli ulcer care was 66% and 19% for patients belonging to the lowest and highest income quartiles, respectively.

Conclusions: Direct costs of Buruli ulcer diagnosis and treatment are catastrophic to a substantial proportion of patients and their families.

Keywords: Buruli ulcer; Cost of illness; Health economics; Illness costs; Mycobacterium ulcerans; Nigeria.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Buruli Ulcer / economics*
  • Buruli Ulcer / therapy*
  • Cross-Sectional Studies
  • Female
  • Health Care Costs / statistics & numerical data*
  • Health Expenditures / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Nigeria
  • Rural Population / statistics & numerical data
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Young Adult