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. 2024 Oct 10;4(10):e0003706.
doi: 10.1371/journal.pgph.0003706. eCollection 2024.

Costs of primary healthcare presentations and hospital admissions for scabies and related skin infections in Fiji, 2018-2019

Edifofon Akpan  1 , Li Jun Thean  2   3 , Rabindra Baskota  1 , Jyotishna Mani  2   4 , Maria Mow  2   4 , Mike Kama  4 , Meciusela Tuicakau  4 , Joseph Kado  4   5   6 , Lucia Romani  7 , John Kaldor  7 , Daniel Engelman  2   3   8 , Andrew C Steer  2   3   8 , Natalie Carvalho  1
Affiliations

Costs of primary healthcare presentations and hospital admissions for scabies and related skin infections in Fiji, 2018-2019

Edifofon Akpan et al. PLOS Glob Public Health. .

Abstract

Scabies and related bacterial skin and soft tissue infections (SSTIs) are highly prevalent in many tropical, low- and middle-income settings. These skin conditions contribute to higher healthcare costs and burdens on healthcare systems. The Big Skin Health Intervention Fiji Trial ("Big SHIFT") carried out surveillance for scabies and SSTIs from July 2018 to June 2019 in the Northern Division of Fiji, an area with high prevalence of scabies, prior to a division-wide ivermectin-based mass drug administration (MDA) campaign. Using data from Big SHIFT, we sought to estimate the annual direct healthcare costs of scabies and related SSTIs for the Northern Division and extrapolate these costs to the national level. We categorized SSTIs as being potentially scabies-related or unlikely scabies-related, based on a previous study. The analysis used a health system perspective, with the main resource use categories of outpatient visits, bed days during admissions, medicines, and diagnostic tests. We extrapolated the total annual number of cases and direct healthcare costs for all divisions in Fiji based upon previous scabies and impetigo prevalence data across all divisions. The average cost per PHC presentation for scabies was US$17.7, and for potentially scabies-related SSTI was $18.3. The average cost per hospital admission for a potentially scabies-related SSTI case was $439. The estimated annual healthcare costs of scabies and related SSTIs in Fiji was US$3.0 million, with cost per capita of $3.3. Scabies and related SSTIs lead to a heavy economic burden in Fiji and prevention would reduce these healthcare costs.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart for extrapolating cases and costs of scabies and potentially scabies-related SSTI to all Fiji divisions.
IR, incidence rate; OR, odds ratio; RR, risk ratio.
Fig 2
Fig 2. One-way sensitivity analysis on the impact of changing the base case parameter values to low and high values on the total annual healthcare costs of scabies and potentially scabies-related SSTIs in Fiji.
Costs are expressed in in 2020 US dollars. Total annual cost is indicated by the black reference line ($2.95 million). See Table 1 for the ranges used for this sensitivity analysis. ICU, intensive care unit; PHC, primary healthcare; SSTI, skin and soft tissue infection.
See this image and copyright information in PMC

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