Economic Impact of a Large-Scale Scabies Upsurge on Healthcare Facilities in Rohingya Refugee Camps: A Retrospective Costing Study

BackgroundScabies is one of the common infectious skin conditions globally, with a significantly high burden in hot and tropical countries, resource-poor settings, and areas with high population density. Rohingya refugee camps in Coxs Bazar are one of the most protracted refugee crises in the world, sheltering approximately 1,143,096 refugees in 33 overcrowded refugee camps. While most existing literature focuses on mass drug administration (MDA) interventions or community-level estimates, the economic burden of scabies on health system is rarely studied and documented. MethodsThis is a retrospective cost study, where we have used financial and epidemiological data from January 2021 to December 2024. Costing was done from the providers perspective, focused on what International Organization for Migration (IOM) spent during the period as a health service provider. Acombination of standard stepdown approach and micro-costing methods were used. Financial data for the study period 2021 to 2024 were collected from the IOM health programmes annual budget and consumption reports. The study population included all individuals who were clinically diagnosed with scabies and received care at 35 IOM-supported health facilities in Ukhiya and Teknaf, Bangladesh. ResultsThe overall estimated financial cost for IOMs scabies outbreak response through its health facilities was USD 2.12 million, with an annual average of USD 531,729. The average cost per scabies management ranged between USD 5.33 and USD 6.54, with the highest in 2021 and the lowest in 2022. Drug costs accounted for 11.92% of the overall cost over 4 years. Of the total cost of $253,629.43 over 4 years, 79% was attributed to permethrin topical cream, which was used to manage an estimated 85% of the total managed cases. Scenario analysis demonstrates that the existing permethrin-based treatment preference is the most expensive treatment modality, compared with ivermectin-based treatment and mixed-treatment approaches. ConclusionAlthough the average cost of treating scabies is relatively low, overall, the treatment cost for such a large population has a significant economic impact. This study found a substantial effect of mass drug administration on reducing the financial burden on the healthcare system.