ArticlePLoS neglected tropical diseases2015
Household costs of leprosy reactions (ENL) in rural India.
Article in PLoS neglected tropical diseases, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03775460 (Methotrexate and Prednisolone Study in Erythema Nodosum Leprosum), which is not on this map. Cited by 35 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Methotrexate and Prednisolone Study in Erythema Nodosum Leprosum (MaPS in ENL
Who cites it
35 citing papers in PubMed, 4 syntheses or guidelines pooled it, 78 citations in OpenAlex.
- A systematic review of adverse effects associated with systemic corticosteroids in the management of leprosy.PLoS neglected tropical diseases · 2026Pooled it
- Descriptions of the natural history of erythema nodosum leprosum to inform clinical classification - A semi-systematic review.PLoS neglected tropical diseases · 2026Pooled it
- Financial hardship among patients suffering from neglected tropical diseases: A systematic review and meta-analysis of global literature.PLoS neglected tropical diseases · 2024Pooled it
- Experiences of living with leprosy: A systematic review and qualitative evidence synthesis.PLoS neglected tropical diseases · 2022Pooled it
- Methotrexate and Prednisolone compared to placebo and prednisolone in the treatment of severe Erythema Nodosum Leprosum: An international multicentre, double-blind randomised controlled clinical trial-MaPs in ENL.PLoS neglected tropical diseases · 2026Trial
- Longitudinal performance of the ENLIST ENL severity scale in individuals with severe erythema nodosum leprosum: Responsiveness, trajectories and clinical features - a secondary analysis of the Methotrexate and Prednisolone study - MaPs in ENL.PLoS neglected tropical diseases · 2026Trial
- Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial.PLoS neglected tropical diseases · 2017Trial
- Dovramilast for Erythema Nodosum Leprosum in Patients With Leprosy in Nepal: Protocol for a Phase 2 Open-Label Pilot Study.JMIR research protocols · 2026Article
- Screening for symptoms of depression, anxiety and associated factors among leprosy patients at referral hospitals in the Amhara region, Ethiopia.BMC psychiatry · 2025Article
- A socio-ecological model of the management of leprosy reactions in Indonesia and India using the experiences of affected individuals, family members and healthcare providers.BMC health services research · 2025Article
- Leprosy.Nature reviews. Disease primers · 2024Review
- A global call for action to tackle skin-related neglected tropical diseases (skin NTDs) through integration: An ambitious step change.PLoS neglected tropical diseases · 2023Article
- Methotrexate as a corticosteroid-sparing agent in leprosy reactions: A French multicenter retrospective study.PLoS neglected tropical diseases · 2023Article
- Metformin as adjunctive therapy in combination with multidrug treatment for multibacillary leprosy: A protocol for a randomized double-blind, controlled Phase 2 trial in Indonesia (MetLep Trial).Wellcome open research · 2023Article
- Understanding leprosy reactions and the impact on the lives of people affected: An exploration in two leprosy endemic countries.PLoS neglected tropical diseases · 2022Article
- Impact of the COVID-19 pandemic on the diagnosis of leprosy in Brazil: An ecological and population-based study.Lancet regional health. Americas · 2022Article
- Evaluation of the influence of genetic variants in Cereblon gene on the response to the treatment of erythema nodosum leprosum with thalidomide.Memorias do Instituto Oswaldo Cruz · 2022Article
- Time-to-Disability Determinants Among Leprosy Patients Enrolled for Treatment at ALERT Center, Addis Ababa, Ethiopia: A Survival Analysis.Infection and drug resistance · 2022Article
- Effectiveness of self-care interventions for integrated morbidity management of skin neglected tropical diseases in Anambra State, Nigeria.BMC public health · 2021Article
- Cost-effectiveness of incorporatingThe Indian journal of medical research · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundErythema nodosum leprosum (ENL) is a common immune-mediated complication of lepromatous (LL) and borderline lepromatous (BL) leprosy. Most patients experience chronic or multiple acute ENL over many years during an economically active period of their lives. Understanding the economic burden of ENL is essential to provide effective patient support, yet this area has not been investigated.
methodsNinety-one patients with LL or BL leprosy attending a leprosy hospital in Purulia district of West Bengal, India, were interviewed using a structured questionnaire. Cases (n = 53) were identified as those who had one or more episodes of ENL within the last 3 years. Controls (n = 38) had LL or BL leprosy but no history of ENL. Data were collected on household income, direct and indirect costs, and coping strategies.
findingsThe total household cost was Rs 1543 per month or 27.9% (IQR 13.2-52.6) of monthly household income for cases, and Rs 237 per month or 4.9% (IQR 1.7-13.4) of monthly household income for controls. Indirect costs accounted for 65% of total household costs for cases. Direct costs accounted for the remaining 35% of household costs, and resulted almost entirely from treatment-seeking in the private sector. Total household costs exceeded 40% of household income for 37.7% of cases (n = 20) and 2.6% of controls (n = 1) [1 USD = 59 INR].
interpretationHouseholds affected by ENL face significant economic burden and are at risk of being pushed further into poverty. Health policy should acknowledge the importance of private sector provision and the significant contribution to total household costs of lost productivity (indirect cost). Further work is needed to explore this area and identify solutions.
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