Provider cost of leptospirosis treatment at a rural hospital in Sri Lanka

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A. M. U. p, Vidanapathirana. J, Amarasekara. J, Karunanayake. L This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5195449/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted 10 You are reading this latest preprint version Abstract Introduction: The rising number of leptospirosis patients and escalating healthcare costs strain the sustainability of free healthcare systems in developing countries like Sri Lanka, posing significant challenges to resource allocation and financial stability in these regions. Objectives: The aim of this study was, to estimate the provider cost of leptospirosis at District General Hospital (DGH) Monaragala, Sri Lanka. Methods: A hospital-based cost estimation study was conducted in DGH Monaragala using the scenario building technique, to assess the provider cost of laboratory confirmed leptospirosis patients using two standard management profiles as uncomplicated ward treated and complicated ward treated. Results: The provider cost per uncomplicated leptospirosis patient (n = 131) treated at ward per day was Rs. 5,449.39 (Rs.5993 with 10% inflation rate) and the total provider cost of an uncomplicated leptospirosis patient treated at ward for an average stay of 4 days was Rs. 21,797.54 (Rs.23,976 with 10% inflation rate) The provider cost per complicated leptospirosis patient (n = 58) treated at ward per day was Rs. 5,695.35 (Rs.6264 with 10% inflation rate) and the total provider cost per complicated leptospirosis for an average stay of 7 days was Rs. 39,867.43 (Rs.43,853 with 10% inflation). Conclusions and Recommendations: The provider cost of leptospirosis in DGH Monaragala was significantly high. Given the inherent challenges in limiting exposure, it is imperative that control efforts prioritize early detection and treatment. Human leptospirosis Disease burden Provider cost Sri Lanka Figures Figure 1 Introduction Leptospirosis is a globally prevalent zoonotic disease. It is caused in humans by over 35 species of Leptospira, primarily transmitted through environmental sources. These bacteria are commonly carried by rodents, especially rats, and farm animals like cattle, pigs, sheep, as well as domestic animals such as dogs. Humans are accidental hosts of the disease, and infection typically results in mild flu-like symptoms. While early treatment with oral antibiotics is often effective, delayed diagnosis during the immune phase of the disease can lead to complications. Approximately 10–15% of cases may progress to severe complications involving multiple organ failures, necessitating specialized medical care. Weil's disease, a well-documented form of severe leptospirosis with pronounced liver and kidney dysfunction, represents only a fraction of the severe complications ( 1 ). According to the “Global Burden of Leptospirosis study” leptospirosis results in a significant global burden, with an estimated loss of about 2.9 million disability-adjusted life years (DALYs) annually ( 2 ). From 2008 to 2015, Sri Lanka experienced an estimated annual caseload of 10,423 leptospirosis cases. The cumulative annual incidence of leptospirosis requiring hospitalization was 52.1 per 100,000 people ( 3 ). In Brazil, where leptospirosis is endemic, they found that a daily increase of $ 1 in per capita household income will associate with 11% risk reduction rate of people testing positive for Leptospira antibodies ( 4 ). Numerous additional analytical investigations have consistently demonstrated a conspicuous and statistically meaningful correlation between leptospirosis and socioeconomic status ( 5 , 6 , 7 ). While the impact of leptospirosis is often felt most acutely by poor urban and rural communities, the economic toll at the national level can also be substantial. The cost of treatment for leptospirosis varies depending on the type of complications and the duration of hospitalization. In the Brazilian study, it was estimated that leptospirosis resulted in $ 4.33 million in lost wages and approximately $ 157,000 in hospitalization costs in 2010 ( 7 ). In many developing countries, there is often a lack of comprehensive analysis regarding the economic burden of diseases from the perspective of service providers, such as hospitals. However, this kind of assessment is critically important for making informed policy decisions and for effectively allocating the limited resources available for healthcare facilities and services. In low- and middle-income countries, institutional care has become a significant sector, consuming a substantial portion of public sector health resources, typically ranging from 50–80% as noted by Chatterjee et al. in 2013 ( 8 ). For countries like Sri Lanka, which offers free healthcare, providing institutional care poses a challenge to ensure the sustainability of this service. Therefore, it is essential to focus on timely disease treatment to prevent complications and to implement control and preventive measures. Provider cost refers to the total expenses incurred by the healthcare service provider in delivering care to the patient. In the context of treating a leptospirosis patient in a healthcare institution, it encompasses the full spectrum of expenses, spanning from the moment the patient registers for care until they are discharged. When calculating the provider cost, various factors come into play, including the expenses related to treatment, medications, diagnostic tests, as well as the personnel involved in inpatient management, laboratory and imaging services, ECGs, and the equipment, furniture, electrical resources, and chemicals used in these procedures. This study aimed to estimate the provider cost of leptospirosis treatment at DGH Monaragala. Situated in the Uva Province, Monaragala is the second-largest district in Sri Lanka and carries a significant leptospirosis burden, with 44.9 Disability-Adjusted Life Years (DALYs) per 100,000 population and the incidence of leptospirosis in the district was recorded at 59.8 per 100,000 population ( 9 ). The findings of this study are expected to offer valuable insights into government expenditure on leptospirosis treatment and to inform cost-effective strategies for disease management and complication prevention. Methods A descriptive cross-sectional study was conducted to estimate the provider cost of treating leptospirosis patients at DGH Monaragala, Sri Lanka, from November 1, 2019, to June 30, 2020. As the primary tertiary referral hospital in the district, DGH Monaragala is the only facility offering ICU care, making it the primary provider for all complicated leptospirosis cases requiring intensive treatment. The hospital has 555 beds across multiple wards and specialized units, including the ICU and Emergency Treatment Unit (ETU). The study enrolled 200 confirmed leptospirosis patients at DGH Monaragala with consent. Exclusions: deceased, transferred, absconded, or left against advice. In Sri Lanka, leptospirosis peaks during the Yala and Maha cultivation seasons. The study, conducted during both seasons, captured a majority of patients, with 73% in 2019 and 71% in 2018 ( 10 ). A checklist was developed to record the instruments, consumables, and services used in patient management, covering the ward, laboratory (hematology and biochemistry), ECG, and radiology departments. The checklist was created with input from various experts, including the Medical Superintendent, Consultant Physicians, Consultant Anesthetists, and senior staff. A consensus-based approach finalized the checklist and allocated utility costs and staff services. The checklist was pre-tested with ten leptospirosis patients, with necessary adjustments made. This approach enabled comprehensive data collection on hospital resources utilized during leptospirosis treatment. The provider cost was estimated from patient admission to discharge or death, excluding out-of-pocket expenses. Costs were categorized into direct health-related costs, covering diagnosis, treatment, and healthcare staff services, and non-health-related costs, including administrative services, patient meals, and utilities. A scenario-building technique with a four-step approach was used for cost estimation (Fig. 1 ). The principal investigator collected data from hospital records, staff, and hospital authorities. Additional information was gathered from the hospital’s purchasing division, biomedical engineering department, accounts branch, and suppliers affiliated with the Ministry of Health. Costs from previous studies conducted within the Sri Lankan healthcare setting were also referred to for comparison. At DGH Monaragala, Consultant Physicians developed treatment profiles (Annex IV) for three categories of laboratory-confirmed leptospirosis patients: uncomplicated cases (without organ involvement), complicated cases (with organ involvement), and ICU patients (with organ involvement and comorbidities). Patients were monitored throughout their hospital stay until they were discharged as cured. The daily cost per patient was determined separately for each category, factoring in all medical services and equipment used throughout the hospital stay ( 11 ). A limitation of the study is that the data used was from 2020. To adjust for this, a 10% inflation rate was applied to the final costs. The detailed breakdown of costs, and the summary costs including the assumptions created related to land, buildings, utilities, staff, drugs, and investigations, was calculated separately (Annex I & Annex II). The cost of meals and tea, utility costs including laundry, cleaning and security was directly obtained from the relevant clerk during the last six-month period and average cost per month was calculated. Monthly cost was apportioned to ward and other investigations according to the decisions taken at the expert committee meeting of DGH Monaragala (Annex III) Costs for the ward equipment directly obtained from the Bio Medical Engineering Division of the Ministry of Health and per day cost was calculated according to the following formula: Per day cost = Unit price (Rs.) x Number in the medical wards / {Life span of the equipment x 365 x Average number of inward patients per day in a medical ward} (Annex I) Cost for electrical equipment directly obtained from the Bio Medical Engineering Division of the Ministry of Health and the cost of furniture were obtained from the purchasing division of the Ministry of Health and the purchasing division of DGH Monaragala. Per day cost was calculated according to the above-mentioned formula. Cost estimation for investigations were done using the same principle for the land, building utilities and staff. Cost estimation for the machines, reagents and other consumables were directly obtained from the Bio Medical Engineering Section and Medical Supplies Division (MSD) of the Ministry of Health, Sri Lanka (Annex I). Cost of the laboratory equipment were obtained from the medical supplied division of the Ministry of Health and the purchasing division of DGH Monaragala. Per day cost was calculated according to the following formula (Annex I): Per day cost = Unit price (Rs.) x Number in the medical wards / {Life span of the equipment x 365 x Average number of inward patients per day} Results Among the 200 patients with confirmed leptospirosis, 131 were categorized as uncomplicated cases, 58 as complicated cases, and 11 required intensive care unit (ICU) admission (Table 1). Additionally, 94.5% of all confirmed cases received treatment in a hospital ward. The cost of medications used for the treatment of uncomplicated, complicated, and ICU-managed leptospirosis patients was calculated separately, based on the treatment protocols followed by the Consultant Physicians of the four wards (Annex IV: Tables 1–4). Table 2 Summary of total cost of management of uncomplicated leptospirosis patient at ward in DGH Monaragala Cost item Description Unit cost (Rs.) Total (Rs.) Cost of ward stay For 4 days 4438.65 17,754.60 Drugs 2768.12 Haematological investigations FBC on admission and discharge 59.62 119.24 Biochemical Serum electrolyte on admission and discharge 130.82 261.64 investigations Serum Creatinine on admission and discharge 106.68 213.36 AST/ALT on admission and discharge 106.86 213.72 UFR on admission and discharge 40.34 80.68 ECG on admission and discharge 193.09 386.18 Total provider cost of one uncomplicated leptospirosis patient treated at ward for 4 days 21,797.54 Table 3 Summary of total cost of management of complicated leptospirosis patient at ward in DGH Monaragala Cost item Description Unit cost (Rs.) Total (Rs.) Cost of ward stay For 7 days 4438.65 31,070.55 Drugs 4560.12 Haematological investigations Full blood count X 8H X 5 days 59.62 894.30 Biochemical Serum electrolytes X daily X 5 days 130.82 654.10 investigations Serum Creatinine X bd X 5 days 106.68 533.40 Liver Function Tests X daily X 5 days 106.86 534.30 UFR X daily X 5 days 40.34 201.70 Radiological investigations Ultra Sound Scans on admission 774.49 774.49 Chest X-rays on admission 258.29 258.29 ECG on admission and discharge 193.09 386.18 Total provider cost per complicated leptospirosis patient treated at ward for 7 days 39,867.43 Table 4 Summary of ICU cost per patient stay with different treatment modalities Description Total Cost (Rs.) ICU cost per patient day (Common Cost Shared by ICU Patients) 24,006.07 ICU cost per patient day with dialysis 24,225.25 ICU cost per patient day with ventilation 32,225.25 ICU cost per patient day with ventilation and dialysis 32,444.43 The provider cost per uncomplicated leptospirosis patient treated in the ward was Rs. 5,449.39 per day, totaling Rs. 21,797.54 for an average 4-day stay (Table 2). For complicated cases, the cost per day was Rs. 5,695.35, with a total of Rs. 39,867.43 for an average 7-day stay (Table 3). A summary of ICU costs per patient, varied by complication: renal (Rs. 26,538.79/day), cardiac (Rs. 28,212.39/day), pulmonary (Rs. 29,657.10/day), neurological (Rs. 26,444.85/day), and multi-organ failure (Rs. 28,363.17/day) (Table 4). The total provider cost for laboratory-confirmed leptospirosis cases at DGH Monaragala was Rs. 7,916,564.52 (Table 5), with 34.7% allocated to managing 11 complicated ICU cases. Targeting the vulnerable group (200 patients) with oral Doxycycline (200mg weekly for 8 weeks) would cost Rs. 112,000.00 (Table 6). Table 5 Total provider cost of total laboratory confirmed leptospirosis patients admitted to DGH Monragala during the study period Description Unit cost (Rs.) Number of patients Total cost (Rs.) Uncomplicated 21,797.54 131 21,797.54 X 131 = 2,855,477.74 Complicated 39,867.43 58 39,867.43 X 58 = 2,312,310.94 All ICU 11 = 2,748,775.84 Total 200 = 7,916,564.52 Table 6 Total cost of 200mg of Doxycycline for 200 patients once a week for 8 weeks Description Unit cost (Rs.) Number of doses Total cost (Rs.) 200mg Doxycycline once a week for 8 weeks for 200 patients 70.00 1600 112,000.00 Total 112,000.00 Discussion This study highlights the significant economic burden of leptospirosis at DGH Monaragala. Several studies have been conducted in Sri Lanka to estimate the cost of a patient per day in ward setting for other diseases but not for leptospirosis. The cost of a patient per day in a medical ward varies in different studies as well as from the present study. E.g. Base Hospital Gampola in 1998 was Rs. 243.00 and cost for a patient per day in a male medical ward in Divisional Hospital Dompe was Rs. 449.00 in 2002 ( 12 , 13 ). Daily cost per patient at the Cancer Institute, Maharagama, was Rs. 527.74 ( 14 ). In comparison, the cost of inpatient care per day at Colombo North Teaching Hospital in 2003 was Rs. 505.70 ( 15 ). Another costing research revealed that the total cost for a patient per day for the treatment of lung cancer attributed to smoking in a ward at Cancer Institute Maharagama was Rs. 1,802.84 ( 16 ). To our knowledge, this is the first study assessing the provider cost incurred due to leptospirosis in a Sri Lankan hospital. From 2002 to 2025, the cost has been increased by approximately twelve times. Further, for the last ten years, cost of a patient day in ward setting seems to have increased nearly by three times. Differences in disease categorization and inflation during the last 10 years with regard to the service charge (as reflected in salary and overtime increases), could be the main reason for the increase of cost of a patient day in ward setting. All patients, regardless of their socioeconomic status, receive complimentary meals and tea; however, only 70% choose to utilize this service (Annex III). According to the present study, the cost of providing meals and tea per patient per day was Rs. 253.56. According to a descriptive cross sectional retrospective study using secondary data to “analyze diet cost for patients admitted to teaching hospital Kalubowila in Colombo, Sri Lanka” revealed that the diet cost for the period of 01.02.2014–28.02.2014 was Rs. 677,042.00 and dietary cost per patient was Rs. 119.00 ( 17 ). The cost of meals and tea seems to have been increased and this could be due to inflation as well as changes of the menus recently. Cost assessment becomes increasingly relevant as ICU survival rates improve. Stakeholders must understand the value derived from ICU expenditures; therefore, indices such as Quality-Adjusted Life Years (QALYs) are gaining importance in evaluating healthcare costs. In this study, the ICU treatment cost for eleven complicated leptospirosis patients accounted for 34.7% of the total provider cost for leptospirosis at DGH Monaragala during the study period (2,748,775.84 / 7,916,564.52 x 100). Although no comparable studies are available from Sri Lanka, a study from the USA reported similar findings, highlighting that ICUs are one of the largest cost drivers in hospital settings, typically accounting for nearly one-third of total inpatient costs ( 18 ). An Indian study on out-of-pocket expenditure and the opportunity cost of leptospirosis patients at a tertiary care hospital found that, despite the availability of free food and transport provided by the government, patients still incurred costs for medications (Rs. 308.8/- or 14%), food (Rs. 173/- or 8%), and travel expenses (Rs. 204.4/- or 9%) ( 19 ). However, this study did not directly compare these expenditures with Sri Lanka’s free healthcare system from a provider cost perspective. The study underscores the significant provider cost of Rs. 7,916,564.52 for managing leptospirosis at DGH Monaragala. In contrast, a proactive approach using oral Doxycycline prophylaxis for 200 vulnerable patients would cost just Rs. 112,000.00, highlighting a highly cost-effective prevention strategy. A costing study from Jamaica in 2018 revealed that in rural areas, the cost of leptospirosis treatment was higher compared to urban areas, but it would be costlier in urban area if the treatment was delayed. In an urban area, the total cost was approximately JMD 80,847 (Rs.110, 210.63 when taken as 1 JMD = 0.0071 USD and 1 USD = Rs.192.00) while in rural areas, the cost was JMD 72,960 (which is Rs.99, 459.07). However, if treated on time, the cost for the urban residents were JMD 18,500 (Rs.25, 219.20) ( 6 ). Further to that, the study from Jamaica highlighted that, the leptospirosis treatment cost was fluctuating due to the number of outbreaks and availability of equipment used to treat leptospirosis. This was the reason for the present study to estimate the provider cost using standard treatment profiles separately according to the different treatment modalities. Another costing study evaluating hospitalization costs associated with leptospirosis in Brazil ( 7 ) revealed that the total hospitalization cost was USD 311,229.95 (Rs. 59,756,150.40 when taken as 1 USD = Rs. 192.00) for normal care and USD 128,726.52 (Rs.24, 715,491.84) for intensive care. That concludes of spending Rs.73, 140.94 for one normal care and Rs.150, 704.22 for one intensive care. Compared to the present study the amount spending for normal care was two times higher (Rs.73, 140.94 versus Rs. 39,867.43) even in 2011, in Brazil. International studies, however, cannot be compared directly with Sri Lankan costing studies related to hospitals due to the differences in geographical setup, treatment guidelines, treatment facilities and differences in currency. Conclusion and Recommendations Given the high provider costs of leptospirosis in Monaragala District, an intensive advocacy program is recommended to enhance risk awareness and preventive actions among key stakeholders at district and regional levels. Strengthening surveillance systems for early detection and response can further aid in controlling disease spread and reducing management costs. Declarations Ethics Approval and Consent to Participate: Ethical approval for the study was obtained from the Ethical Review Committee, Faculty of Medicine, University of Colombo (Reference: EC-18-066, extended to 2019). Permission to conduct the study was granted by the Director of DGH Monaragala and the Regional Director of Health Services (RDHS) Monaragala. Informed written consent was obtained from all study participants. Consent for Publication: All authors provided consent. Availability of Data and Material: Available upon request. Competing Interests: None. Funding: Self-funded. Authors' Contributions: Kumari A. M. U. P. wrote the article and handled correspondence. All other authors, including Vidanapathirana J., Amarasekara J., and Karunanayake L., supervised, reviewed the work, and provided expert opinions. Acknowledgements: Authors are most grateful to Dr. R.M.D.Rathnayaka for expert advice on the study and encouraging discussions. Dr. Chaminda Kottage, Consultant Physician, all medical officers, and all nursing officers in 4 medical units at DGH Monaragala for helping the data collection. References Agampodi, S., Gunarathna, S., Lee, J. S., & Excler, J. L. (2023). Global, regional, and country-level cost of leptospirosis due to loss of productivity in humans. PLOS Neglected Tropical Diseases, 17 (8), e0011291. Torgerson, P. R., Hagan, J. E., Costa, F., Calcagno, J., Kane, M., Martinez-Silveira, M. S., ... & Abela-Ridder, B. (2015). Global burden of leptospirosis: estimated in terms of disability-adjusted life years. 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Prevalence and associated factors of smoking among adult males in Colombo District and cost of treatment of lung cancer attributed to smoking. Doctor of Medicine , Postgraduate Institute of Medicine, University of Colombo. Rathnayake, R. M. S. S., & De Silva, D. (2016). Diet cost of patients in Teaching Hospital Kalubowila. Anuradhapura Medical Journal, 10 (1), 1–6. https://doi.org/10.4038/amj.v10i1.7596 Dasta, J. F., McLaughlin, T. P., Mody, S. H., & Piech, C. T. (2005). Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Critical care medicine, 33(6), 1266-1271. Prahlad, S. R., Baxi, R. K., & Godara, N. (2020). Out-of-Pocket Expenditure and Opportunity Cost of Leptospirosis Patients at a Tertiary Care Hospital of Gujarat, India. Indian Journal of Community Medicine, 45(3), 363-366. Table 1 Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx ANNEXI.pdf ANNEXII.docx ANNEXIII.pdf ANNEXIV.docx Cite Share Download PDF Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 08 May, 2025 Reviews received at journal 03 Apr, 2025 Reviews received at journal 29 Mar, 2025 Reviewers agreed at journal 25 Mar, 2025 Reviews received at journal 25 Mar, 2025 Reviewers agreed at journal 25 Mar, 2025 Reviewers agreed at journal 25 Mar, 2025 Reviewers invited by journal 24 Mar, 2025 Submission checks completed at journal 20 Mar, 2025 First submitted to journal 13 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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L","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Karunanayake.","middleName":"","lastName":"L","suffix":""}],"badges":[],"createdAt":"2024-10-03 02:38:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5195449/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5195449/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-025-11211-y","type":"published","date":"2025-07-01T15:58:42+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79321158,"identity":"571d2009-8f8a-4b53-bbdc-9768be404d63","added_by":"auto","created_at":"2025-03-27 04:29:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":96357,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eFour steps of scenario-building technique\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5195449/v1/8094d296ae05eb72427921c6.png"},{"id":86180829,"identity":"f4baf366-dc4a-478d-8d3f-ce4f08c298e4","added_by":"auto","created_at":"2025-07-07 16:22:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":692408,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5195449/v1/f45aa1d9-28ee-46f9-9ff3-a46bcabc62e8.pdf"},{"id":79321157,"identity":"d1976305-d184-417c-b9eb-52e24f5d8053","added_by":"auto","created_at":"2025-03-27 04:29:53","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18804,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5195449/v1/b323d78c927b229bbf531c94.docx"},{"id":79321161,"identity":"85a190f8-b1c0-49fd-8902-b8c4364ee62c","added_by":"auto","created_at":"2025-03-27 04:29:53","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":682693,"visible":true,"origin":"","legend":"","description":"","filename":"ANNEXI.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5195449/v1/b259773db24ec5c879902cb0.pdf"},{"id":79322051,"identity":"42ba5d2d-4918-4be1-af77-b37a9121823a","added_by":"auto","created_at":"2025-03-27 04:37:53","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":45779,"visible":true,"origin":"","legend":"","description":"","filename":"ANNEXII.docx","url":"https://assets-eu.researchsquare.com/files/rs-5195449/v1/bef3e8b6c66dcc845b236942.docx"},{"id":79322055,"identity":"eb08b159-ea9a-4b17-b2e0-815e81a6161f","added_by":"auto","created_at":"2025-03-27 04:37:53","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":412204,"visible":true,"origin":"","legend":"","description":"","filename":"ANNEXIII.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5195449/v1/839fa5ce2d1d0e5160f8701a.pdf"},{"id":79322828,"identity":"d26df5a8-a4b7-4d95-ae6a-69109284eaaa","added_by":"auto","created_at":"2025-03-27 04:45:53","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":26422,"visible":true,"origin":"","legend":"","description":"","filename":"ANNEXIV.docx","url":"https://assets-eu.researchsquare.com/files/rs-5195449/v1/d62dea527ae7f47e1207835f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Provider cost of leptospirosis treatment at a rural hospital in Sri Lanka","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLeptospirosis is a globally prevalent zoonotic disease. It is caused in humans by over 35 species of Leptospira, primarily transmitted through environmental sources. These bacteria are commonly carried by rodents, especially rats, and farm animals like cattle, pigs, sheep, as well as domestic animals such as dogs. Humans are accidental hosts of the disease, and infection typically results in mild flu-like symptoms. While early treatment with oral antibiotics is often effective, delayed diagnosis during the immune phase of the disease can lead to complications. Approximately 10\u0026ndash;15% of cases may progress to severe complications involving multiple organ failures, necessitating specialized medical care. Weil's disease, a well-documented form of severe leptospirosis with pronounced liver and kidney dysfunction, represents only a fraction of the severe complications (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the \u0026ldquo;Global Burden of Leptospirosis study\u0026rdquo; leptospirosis results in a significant global burden, with an estimated loss of about 2.9\u0026nbsp;million disability-adjusted life years (DALYs) annually (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). From 2008 to 2015, Sri Lanka experienced an estimated annual caseload of 10,423 leptospirosis cases. The cumulative annual incidence of leptospirosis requiring hospitalization was 52.1 per 100,000 people (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In Brazil, where leptospirosis is endemic, they found that a daily increase of \u003cspan\u003e$\u003c/span\u003e1 in per capita household income will associate with 11% risk reduction rate of people testing positive for Leptospira antibodies (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Numerous additional analytical investigations have consistently demonstrated a conspicuous and statistically meaningful correlation between leptospirosis and socioeconomic status (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). While the impact of leptospirosis is often felt most acutely by poor urban and rural communities, the economic toll at the national level can also be substantial. The cost of treatment for leptospirosis varies depending on the type of complications and the duration of hospitalization. In the Brazilian study, it was estimated that leptospirosis resulted in \u003cspan\u003e$\u003c/span\u003e4.33\u0026nbsp;million in lost wages and approximately \u003cspan\u003e$\u003c/span\u003e157,000 in hospitalization costs in 2010 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn many developing countries, there is often a lack of comprehensive analysis regarding the economic burden of diseases from the perspective of service providers, such as hospitals. However, this kind of assessment is critically important for making informed policy decisions and for effectively allocating the limited resources available for healthcare facilities and services. In low- and middle-income countries, institutional care has become a significant sector, consuming a substantial portion of public sector health resources, typically ranging from 50\u0026ndash;80% as noted by Chatterjee et al. in 2013 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). For countries like Sri Lanka, which offers free healthcare, providing institutional care poses a challenge to ensure the sustainability of this service. Therefore, it is essential to focus on timely disease treatment to prevent complications and to implement control and preventive measures.\u003c/p\u003e \u003cp\u003eProvider cost refers to the total expenses incurred by the healthcare service provider in delivering care to the patient. In the context of treating a leptospirosis patient in a healthcare institution, it encompasses the full spectrum of expenses, spanning from the moment the patient registers for care until they are discharged. When calculating the provider cost, various factors come into play, including the expenses related to treatment, medications, diagnostic tests, as well as the personnel involved in inpatient management, laboratory and imaging services, ECGs, and the equipment, furniture, electrical resources, and chemicals used in these procedures.\u003c/p\u003e \u003cp\u003eThis study aimed to estimate the provider cost of leptospirosis treatment at DGH Monaragala. Situated in the Uva Province, Monaragala is the second-largest district in Sri Lanka and carries a significant leptospirosis burden, with 44.9 Disability-Adjusted Life Years (DALYs) per 100,000 population and the incidence of leptospirosis in the district was recorded at 59.8 per 100,000 population (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The findings of this study are expected to offer valuable insights into government expenditure on leptospirosis treatment and to inform cost-effective strategies for disease management and complication prevention.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA descriptive cross-sectional study was conducted to estimate the provider cost of treating leptospirosis patients at DGH Monaragala, Sri Lanka, from November 1, 2019, to June 30, 2020. As the primary tertiary referral hospital in the district, DGH Monaragala is the only facility offering ICU care, making it the primary provider for all complicated leptospirosis cases requiring intensive treatment. The hospital has 555 beds across multiple wards and specialized units, including the ICU and Emergency Treatment Unit (ETU). The study enrolled 200 confirmed leptospirosis patients at DGH Monaragala with consent. Exclusions: deceased, transferred, absconded, or left against advice. In Sri Lanka, leptospirosis peaks during the Yala and Maha cultivation seasons. The study, conducted during both seasons, captured a majority of patients, with 73% in 2019 and 71% in 2018 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA checklist was developed to record the instruments, consumables, and services used in patient management, covering the ward, laboratory (hematology and biochemistry), ECG, and radiology departments. The checklist was created with input from various experts, including the Medical Superintendent, Consultant Physicians, Consultant Anesthetists, and senior staff. A consensus-based approach finalized the checklist and allocated utility costs and staff services. The checklist was pre-tested with ten leptospirosis patients, with necessary adjustments made. This approach enabled comprehensive data collection on hospital resources utilized during leptospirosis treatment.\u003c/p\u003e \u003cp\u003eThe provider cost was estimated from patient admission to discharge or death, excluding out-of-pocket expenses. Costs were categorized into direct health-related costs, covering diagnosis, treatment, and healthcare staff services, and non-health-related costs, including administrative services, patient meals, and utilities. A scenario-building technique with a four-step approach was used for cost estimation (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe principal investigator collected data from hospital records, staff, and hospital authorities. Additional information was gathered from the hospital\u0026rsquo;s purchasing division, biomedical engineering department, accounts branch, and suppliers affiliated with the Ministry of Health. Costs from previous studies conducted within the Sri Lankan healthcare setting were also referred to for comparison.\u003c/p\u003e \u003cp\u003eAt DGH Monaragala, Consultant Physicians developed treatment profiles (Annex IV) for three categories of laboratory-confirmed leptospirosis patients: uncomplicated cases (without organ involvement), complicated cases (with organ involvement), and ICU patients (with organ involvement and comorbidities). Patients were monitored throughout their hospital stay until they were discharged as cured. The daily cost per patient was determined separately for each category, factoring in all medical services and equipment used throughout the hospital stay (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). A limitation of the study is that the data used was from 2020. To adjust for this, a 10% inflation rate was applied to the final costs.\u003c/p\u003e \u003cp\u003eThe detailed breakdown of costs, and the summary costs including the assumptions created related to land, buildings, utilities, staff, drugs, and investigations, was calculated separately (Annex I \u0026amp; Annex II). The cost of meals and tea, utility costs including laundry, cleaning and security was directly obtained from the relevant clerk during the last six-month period and average cost per month was calculated. Monthly cost was apportioned to ward and other investigations according to the decisions taken at the expert committee meeting of DGH Monaragala (Annex III)\u003c/p\u003e \u003cp\u003eCosts for the ward equipment directly obtained from the Bio Medical Engineering Division of the Ministry of Health and per day cost was calculated according to the following formula:\u003c/p\u003e \u003cp\u003ePer day cost\u0026thinsp;=\u0026thinsp;Unit price (Rs.) x Number in the medical wards / {Life span of the equipment x 365 x Average number of inward patients per day in a medical ward} (Annex I)\u003c/p\u003e \u003cp\u003eCost for electrical equipment directly obtained from the Bio Medical Engineering Division of the Ministry of Health and the cost of furniture were obtained from the purchasing division of the Ministry of Health and the purchasing division of DGH Monaragala. Per day cost was calculated according to the above-mentioned formula.\u003c/p\u003e \u003cp\u003eCost estimation for investigations were done using the same principle for the land, building utilities and staff. Cost estimation for the machines, reagents and other consumables were directly obtained from the Bio Medical Engineering Section and Medical Supplies Division (MSD) of the Ministry of Health, Sri Lanka (Annex I). Cost of the laboratory equipment were obtained from the medical supplied division of the Ministry of Health and the purchasing division of DGH Monaragala. Per day cost was calculated according to the following formula (Annex I):\u003c/p\u003e \u003cp\u003ePer day cost\u0026thinsp;=\u0026thinsp;Unit price (Rs.) x Number in the medical wards / {Life span of the equipment x 365 x Average number of inward patients per day}\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the 200 patients with confirmed leptospirosis, 131 were categorized as uncomplicated cases, 58 as complicated cases, and 11 required intensive care unit (ICU) admission (Table 1). Additionally, 94.5% of all confirmed cases received treatment in a hospital ward.\u003c/p\u003e\n\u003cdiv\u003e\u003c/div\u003e\n\u003cp\u003eThe cost of medications used for the treatment of uncomplicated, complicated, and ICU-managed leptospirosis patients was calculated separately, based on the treatment protocols followed by the Consultant Physicians of the four wards (Annex IV: Tables 1\u0026ndash;4).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSummary of total cost of management of uncomplicated leptospirosis patient at ward in DGH Monaragala\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCost item\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDescription\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUnit cost (Rs.)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal (Rs.)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCost of ward stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFor 4 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4438.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17,754.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDrugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2768.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHaematological investigations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFBC on admission and discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBiochemical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum electrolyte on admission and discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e261.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003einvestigations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum Creatinine on admission and discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e213.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAST/ALT on admission and discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e213.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUFR on admission and discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eECG on admission and discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e193.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e386.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal provider cost of one uncomplicated leptospirosis patient treated at ward for 4 days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e21,797.54\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSummary of total cost of management of complicated leptospirosis patient at ward in DGH Monaragala\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCost item\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDescription\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUnit cost (Rs.)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal (Rs.)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCost of ward stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFor 7 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4438.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31,070.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDrugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4560.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHaematological investigations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFull blood count X 8H X 5 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e894.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBiochemical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum electrolytes X daily X 5 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e654.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003einvestigations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum Creatinine X bd X 5 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e533.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiver Function Tests X daily X 5 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e534.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUFR X daily X 5 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e201.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRadiological investigations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUltra Sound Scans on admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e774.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e774.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChest X-rays on admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e258.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e258.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eECG on admission and discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e193.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e386.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal provider cost per complicated leptospirosis patient treated at ward for 7 days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e39,867.43\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSummary of ICU cost per patient stay with different treatment modalities\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDescription\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal Cost (Rs.)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eICU cost per patient day (Common Cost Shared by ICU Patients)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24,006.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eICU cost per patient day with dialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24,225.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eICU cost per patient day with ventilation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32,225.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eICU cost per patient day with ventilation and dialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32,444.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe provider cost per uncomplicated leptospirosis patient treated in the ward was Rs. 5,449.39 per day, totaling Rs. 21,797.54 for an average 4-day stay (Table 2). For complicated cases, the cost per day was Rs. 5,695.35, with a total of Rs. 39,867.43 for an average 7-day stay (Table 3).\u003c/p\u003e\n\u003cp\u003eA summary of ICU costs per patient, varied by complication: renal (Rs. 26,538.79/day), cardiac (Rs. 28,212.39/day), pulmonary (Rs. 29,657.10/day), neurological (Rs. 26,444.85/day), and multi-organ failure (Rs. 28,363.17/day) (Table 4). The total provider cost for laboratory-confirmed leptospirosis cases at DGH Monaragala was Rs. 7,916,564.52 (Table 5), with 34.7% allocated to managing 11 complicated ICU cases. Targeting the vulnerable group (200 patients) with oral Doxycycline (200mg weekly for 8 weeks) would cost Rs. 112,000.00 (Table 6).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eTotal provider cost of total laboratory confirmed leptospirosis patients admitted to DGH Monragala during the study period\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDescription\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUnit cost (Rs.)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of patients\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal cost (Rs.)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUncomplicated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21,797.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21,797.54 X 131\u0026thinsp;=\u0026thinsp;2,855,477.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplicated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39,867.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39,867.43 X 58 = 2,312,310.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAll ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e= 2,748,775.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e200\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e= 7,916,564.52\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 6\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eTotal cost of 200mg of Doxycycline for 200 patients once a week for 8 weeks\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDescription\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUnit cost (Rs.)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of doses\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal cost (Rs.)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e200mg Doxycycline once a week for 8 weeks for 200 patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112,000.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e112,000.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights the significant economic burden of leptospirosis at DGH Monaragala. Several studies have been conducted in Sri Lanka to estimate the cost of a patient per day in ward setting for other diseases but not for leptospirosis. The cost of a patient per day in a medical ward varies in different studies as well as from the present study. E.g. Base Hospital Gampola in 1998 was Rs. 243.00 and cost for a patient per day in a male medical ward in Divisional Hospital Dompe was Rs. 449.00 in 2002 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Daily cost per patient at the Cancer Institute, Maharagama, was Rs. 527.74 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In comparison, the cost of inpatient care per day at Colombo North Teaching Hospital in 2003 was Rs. 505.70 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Another costing research revealed that the total cost for a patient per day for the treatment of lung cancer attributed to smoking in a ward at Cancer Institute Maharagama was Rs. 1,802.84 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). To our knowledge, this is the first study assessing the provider cost incurred due to leptospirosis in a Sri Lankan hospital.\u003c/p\u003e \u003cp\u003eFrom 2002 to 2025, the cost has been increased by approximately twelve times. Further, for the last ten years, cost of a patient day in ward setting seems to have increased nearly by three times. Differences in disease categorization and inflation during the last 10 years with regard to the service charge (as reflected in salary and overtime increases), could be the main reason for the increase of cost of a patient day in ward setting.\u003c/p\u003e \u003cp\u003eAll patients, regardless of their socioeconomic status, receive complimentary meals and tea; however, only 70% choose to utilize this service (Annex III). According to the present study, the cost of providing meals and tea per patient per day was Rs. 253.56. According to a descriptive cross sectional retrospective study using secondary data to \u0026ldquo;analyze diet cost for patients admitted to teaching hospital Kalubowila in Colombo, Sri Lanka\u0026rdquo; revealed that the diet cost for the period of 01.02.2014\u0026ndash;28.02.2014 was Rs. 677,042.00 and dietary cost per patient was Rs. 119.00 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The cost of meals and tea seems to have been increased and this could be due to inflation as well as changes of the menus recently.\u003c/p\u003e \u003cp\u003eCost assessment becomes increasingly relevant as ICU survival rates improve. Stakeholders must understand the value derived from ICU expenditures; therefore, indices such as Quality-Adjusted Life Years (QALYs) are gaining importance in evaluating healthcare costs. In this study, the ICU treatment cost for eleven complicated leptospirosis patients accounted for 34.7% of the total provider cost for leptospirosis at DGH Monaragala during the study period (2,748,775.84 / 7,916,564.52 x 100). Although no comparable studies are available from Sri Lanka, a study from the USA reported similar findings, highlighting that ICUs are one of the largest cost drivers in hospital settings, typically accounting for nearly one-third of total inpatient costs (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAn Indian study on out-of-pocket expenditure and the opportunity cost of leptospirosis patients at a tertiary care hospital found that, despite the availability of free food and transport provided by the government, patients still incurred costs for medications (Rs. 308.8/- or 14%), food (Rs. 173/- or 8%), and travel expenses (Rs. 204.4/- or 9%) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). However, this study did not directly compare these expenditures with Sri Lanka\u0026rsquo;s free healthcare system from a provider cost perspective.\u003c/p\u003e \u003cp\u003eThe study underscores the significant provider cost of Rs. 7,916,564.52 for managing leptospirosis at DGH Monaragala. In contrast, a proactive approach using oral Doxycycline prophylaxis for 200 vulnerable patients would cost just Rs. 112,000.00, highlighting a highly cost-effective prevention strategy.\u003c/p\u003e \u003cp\u003eA costing study from Jamaica in 2018 revealed that in rural areas, the cost of leptospirosis treatment was higher compared to urban areas, but it would be costlier in urban area if the treatment was delayed. In an urban area, the total cost was approximately JMD 80,847 (Rs.110, 210.63 when taken as 1 JMD\u0026thinsp;=\u0026thinsp;0.0071 USD and 1 USD\u0026thinsp;=\u0026thinsp;Rs.192.00) while in rural areas, the cost was JMD 72,960 (which is Rs.99, 459.07). However, if treated on time, the cost for the urban residents were JMD 18,500 (Rs.25, 219.20) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Further to that, the study from Jamaica highlighted that, the leptospirosis treatment cost was fluctuating due to the number of outbreaks and availability of equipment used to treat leptospirosis. This was the reason for the present study to estimate the provider cost using standard treatment profiles separately according to the different treatment modalities.\u003c/p\u003e \u003cp\u003eAnother costing study evaluating hospitalization costs associated with leptospirosis in Brazil (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) revealed that the total hospitalization cost was USD 311,229.95 (Rs. 59,756,150.40 when taken as 1 USD\u0026thinsp;=\u0026thinsp;Rs. 192.00) for normal care and USD 128,726.52 (Rs.24, 715,491.84) for intensive care. That concludes of spending Rs.73, 140.94 for one normal care and Rs.150, 704.22 for one intensive care. Compared to the present study the amount spending for normal care was two times higher (Rs.73, 140.94 versus Rs. 39,867.43) even in 2011, in Brazil. International studies, however, cannot be compared directly with Sri Lankan costing studies related to hospitals due to the differences in geographical setup, treatment guidelines, treatment facilities and differences in currency.\u003c/p\u003e"},{"header":"Conclusion and Recommendations","content":"\u003cp\u003eGiven the high provider costs of leptospirosis in Monaragala District, an intensive advocacy program is recommended to enhance risk awareness and preventive actions among key stakeholders at district and regional levels. Strengthening surveillance systems for early detection and response can further aid in controlling disease spread and reducing management costs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Approval and Consent to Participate: Ethical approval for the study was obtained from the Ethical Review Committee, Faculty of Medicine, University of Colombo (Reference: EC-18-066, extended to 2019). Permission to conduct the study was granted by the Director of DGH Monaragala and the Regional Director of Health Services (RDHS) Monaragala. Informed written consent was obtained from all study participants.\u003c/p\u003e\n\u003cp\u003eConsent for Publication: All authors provided consent.\u003c/p\u003e\n\u003cp\u003eAvailability of Data and Material: Available upon request.\u003c/p\u003e\n\u003cp\u003eCompeting Interests: None.\u003c/p\u003e\n\u003cp\u003eFunding: Self-funded.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; Contributions: Kumari A. M. U. P. wrote the article and handled correspondence. All other authors, including Vidanapathirana J., Amarasekara J., and Karunanayake L., supervised, reviewed the work, and provided expert opinions.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: Authors are most grateful to Dr. R.M.D.Rathnayaka for expert advice on the study and encouraging discussions. Dr. Chaminda Kottage, Consultant Physician, all medical officers, and all nursing officers in 4 medical units at DGH Monaragala for helping the data collection.\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAgampodi, S., Gunarathna, S., Lee, J. S., \u0026amp; Excler, J. L. (2023). Global, regional, and country-level cost of leptospirosis due to loss of productivity in humans. \u003cem\u003ePLOS Neglected Tropical Diseases, 17\u003c/em\u003e(8), e0011291.\u003c/li\u003e\n\u003cli\u003eTorgerson, P. R., Hagan, J. E., Costa, F., Calcagno, J., Kane, M., Martinez-Silveira, M. S., ... \u0026amp; Abela-Ridder, B. (2015). Global burden of leptospirosis: estimated in terms of disability-adjusted life years. \u003cem\u003ePLOS Neglected Tropical Diseases, 9\u003c/em\u003e(10), e0004122.\u003c/li\u003e\n\u003cli\u003eWarnasekara, J., Koralegedara, I., \u0026amp; Agampodi, S. (2019). Estimating the burden of leptospirosis in Sri Lanka; a systematic review. BMC Infectious Diseases, 19, 1-12.\u003c/li\u003e\n\u003cli\u003eReis, R. B., Ribeiro, G. S., Felzemburgh, R. D., Santana, F. S., Mohr, S., Melendez, A. X., ... \u0026amp; Ko, A. I. (2008). Impact of environment and social gradient on \u003cem\u003eLeptospira\u003c/em\u003e infection in urban slums. \u003cem\u003ePLOS Neglected Tropical Diseases, 2\u003c/em\u003e(4), e228.\u003c/li\u003e\n\u003cli\u003eArbiol, J., Orencio, P. M., Romena, N., Nomura, H., Takahashi, Y., \u0026amp; Yabe, M. (2016). Knowledge, attitude, and practices towards leptospirosis among lakeshore communities of Calamba and Los Ba\u0026ntilde;os, Laguna, Philippines. \u003cem\u003eAgriculture (Switzerland), 6\u003c/em\u003e(2), 18. https://doi.org/10.3390/agriculture6020018\u003c/li\u003e\n\u003cli\u003eBryan-Thomas, J., Collins, K., Omoregie, J., \u0026amp; Levy, A. (2018). What is the cost of leptospirosis treatment in Jamaica? A cross-sectional study. \u003cem\u003eAmerican Journal of Public Health Research, 6\u003c/em\u003e(3), 166\u0026ndash;172. https://doi.org/10.12691/ajphr-6-3-7\u003c/li\u003e\n\u003cli\u003eSouza, V. M. M. D., Arsky, M. D. L. N. S., Castro, A. P. B. D., \u0026amp; Araujo, W. N. D. (2011). Years of potential life lost and hospitalization costs associated with leptospirosis in Brazil. \u003cem\u003eRevista de Sa\u0026uacute;de P\u0026uacute;blica, 45\u003c/em\u003e, 1001\u0026ndash;1008. https://doi.org/10.1590/S0034-89102011005000070\u003c/li\u003e\n\u003cli\u003eChatterjee, S., Levin, C., \u0026amp; Laxminarayan, R. (2013). Unit cost of medical services at different hospitals in India. \u003cem\u003ePLOS ONE, 8\u003c/em\u003e(7), e69728. https://doi.org/10.1371/journal.pone.0069728\u003c/li\u003e\n\u003cli\u003eKumari, A. M. U. P., Vidanapathirana, J., Amarasekara, J., \u0026amp; Karunanayake, L. (2024). Disability‐adjusted life years due to leptospirosis in Monaragala District of Sri Lanka. Zoonoses and Public Health, 71(1), 98\u0026ndash;106.\u003c/li\u003e\n\u003cli\u003ehttps://www.epid.gov.lk\u003c/li\u003e\n\u003cli\u003eAgrawal, A., Gandhe, M. B., Gandhe, S., \u0026amp; Agrawal, N. (2017). Study of length of stay and average cost of treatment in Medicine Intensive Care Unit at a tertiary care center. Journal of Health Research and Reviews (In Developing Countries), 4(1), 24\u0026ndash;29.\u003c/li\u003e\n\u003cli\u003eSiriwardena, K. A. R. S. (1998). Cost analysis of indoor treatment of patients at Base Hospital, Gampola. (MSc thesis). Postgraduate Institute of Medicine, University of Colombo.\u003c/li\u003e\n\u003cli\u003eEdirisinghe, E. A. K. K. (2002). Cost analysis of patient care services at the District Hospital (MSc thesis). Postgraduate Institute of Medicine, University of Colombo.\u003c/li\u003e\n\u003cli\u003eGamage, D. G. (2009). Prevalence of carcinogenic human papillomavirus infection and burden of cervical cancer attributable to it in the District of Gampaha. Doctor of Medicine, Postgraduate Institute of Medicine, University of Colombo.\u003c/li\u003e\n\u003cli\u003eKasturirathne, K. T. A. A. (2003). Morbidity pattern and economic burden of non-communicable diseases at the tertiary care level (MSc thesis). Postgraduate Institute of Medicine, University of Colombo.\u003c/li\u003e\n\u003cli\u003eChulasiri, P. U., Gunawardana, N. S., \u0026amp; De Silva, A. (2014). Prevalence and associated factors of smoking among adult males in Colombo District and cost of treatment of lung cancer attributed to smoking. Doctor of Medicine\u003cem\u003e, Postgraduate Institute of Medicine, \u003c/em\u003e\u003cem\u003eUniversity of Colombo.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eRathnayake, R. M. S. S., \u0026amp; De Silva, D. (2016). Diet cost of patients in Teaching Hospital Kalubowila. \u003cem\u003eAnuradhapura Medical Journal, 10\u003c/em\u003e(1), 1\u0026ndash;6. https://doi.org/10.4038/amj.v10i1.7596\u003c/li\u003e\n\u003cli\u003eDasta, J. F., McLaughlin, T. P., Mody, S. H., \u0026amp; Piech, C. T. (2005). Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Critical care medicine, 33(6), 1266-1271. \u003c/li\u003e\n\u003cli\u003ePrahlad, S. R., Baxi, R. K., \u0026amp; Godara, N. (2020). Out-of-Pocket Expenditure and Opportunity Cost of Leptospirosis Patients at a Tertiary Care Hospital of Gujarat, India. Indian Journal of Community Medicine, 45(3), 363-366.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Human leptospirosis, Disease burden, Provider cost, Sri Lanka","lastPublishedDoi":"10.21203/rs.3.rs-5195449/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5195449/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe rising number of leptospirosis patients and escalating healthcare costs strain the sustainability of free healthcare systems in developing countries like Sri Lanka, posing significant challenges to resource allocation and financial stability in these regions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of this study was, to estimate the provider cost of leptospirosis at District General Hospital (DGH) Monaragala, Sri Lanka.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA hospital-based cost estimation study was conducted in DGH Monaragala using the scenario building technique, to assess the provider cost of laboratory confirmed leptospirosis patients using two standard management profiles as uncomplicated ward treated and complicated ward treated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe provider cost per uncomplicated leptospirosis patient (n = 131) treated at ward per day was Rs. 5,449.39 (Rs.5993 with 10% inflation rate) and the total provider cost of an uncomplicated leptospirosis patient treated at ward for an average stay of 4 days was Rs. 21,797.54 (Rs.23,976 with 10% inflation rate) The provider cost per complicated leptospirosis patient (n = 58) treated at ward per day was Rs. 5,695.35 (Rs.6264 with 10% inflation rate) and the total provider cost per complicated leptospirosis for an average stay of 7 days was Rs. 39,867.43 (Rs.43,853 with 10% inflation).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions and Recommendations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe provider cost of leptospirosis in DGH Monaragala was significantly high. Given the inherent challenges in limiting exposure, it is imperative that control efforts prioritize early detection and treatment.\u003c/p\u003e","manuscriptTitle":"Provider cost of leptospirosis treatment at a rural hospital in Sri Lanka","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-27 04:29:49","doi":"10.21203/rs.3.rs-5195449/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-08T14:03:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-03T07:22:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-29T11:11:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158735176004339064336408211854257698453","date":"2025-03-26T03:35:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-25T14:40:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261023822230568996979769530380529407972","date":"2025-03-25T14:27:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256244611478098013281881774683412383995","date":"2025-03-25T06:16:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-24T22:54:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-20T12:17:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-03-13T12:42:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7c88616a-1358-45e3-a11a-b19108e77b3f","owner":[],"postedDate":"March 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:20:34+00:00","versionOfRecord":{"articleIdentity":"rs-5195449","link":"https://doi.org/10.1186/s12879-025-11211-y","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2025-07-01 15:58:42","publishedOnDateReadable":"July 1st, 2025"},"versionCreatedAt":"2025-03-27 04:29:49","video":"","vorDoi":"10.1186/s12879-025-11211-y","vorDoiUrl":"https://doi.org/10.1186/s12879-025-11211-y","workflowStages":[]},"version":"v1","identity":"rs-5195449","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5195449","identity":"rs-5195449","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}