Economic burden of recurrent vulvovaginal candidiasis in Uganda: a cost-of-illness analysis.

Objectives: Recurrent vulvovaginal candidiasis (rVVC) affects 6-9% of women worldwide, yet its economic impact in resource-limited settings remains poorly understood. This study estimated the economic burden of rVVC in Uganda from a societal perspective. Methods: We used a cost-of-illness framework using secondary data sources. We modeled the rVVC prevalence by adjusting for three major epidemiologic risk factors: HIV infection, hormonal contraceptive use, and broad-spectrum antibiotic exposure. Direct medical costs were calculated using Uganda's health care system pricing, whereas indirect costs were estimated using local wage data. Costs were adjusted for pharmaceutical markups (50-60%) and health-specific inflation (6.0%). Prevalence was determined using epidemiologic data adapted to Uganda's female population aged 15-49 years. Sensitivity analyses addressed uncertainty in prevalence rates, health care-seeking behaviors, episode frequency, and wage variability. Results: The annual economic burden of rVVC in Uganda was estimated at Uganda shillings 280.077 billion (US $75.696 million), equivalent to approximately 11.22% of the total health care expenditure. Direct medical costs accounted for 71.5% of the total. The average annual cost per patient was Uganda shillings 260,082 (US $70.29), which is approximately 7.0% of per-capita gross domestic product. Health care-seeking behavior and prevalence were the most influential parameters in sensitivity analyses. Conclusions: rVVC imposes a substantial economic burden on Ugandan women and the health care system. Our findings highlight the need for enhanced screening, improved diagnostics and therapeutic approaches, and preventive strategies.