Indonesian Journal of Health Administration Original Research (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
THE HIDDEN ECONOMIC BURDEN OF LEPTOSPIROSIS:
HEALTHCARE COSTS AND PATIENT IMPACT
Beban Ekonomi Tersembunyi Leptospirosis: Analisis Biaya Kesehatan dan Dampak Finansial pada Pasien Wahyu Pudji Nugraheni1.
Sinta Dewi Lestyoningrum 1*.
Indah Pawitaningtyas1.
Syarifah Nuraini1.
Linta Meyla Putri2 .
Ristiyanto1 .
Carine Milcent3 1Research Center for Public Health and Nutrition.
Research Organization for Health.
National Research and Innovation Agency of Indonesia.
Bogor.
Indonesia.
2STIKes Adi Husada Surabaya.
Surabaya.
Indonesia.
3Paris School of Economics.
Paris.
France.
Correspondence*:
Address: Bogor Street No.
Nanggewer Mekar.
Bogor District.
Indonesia | e-mail: sint005@brin.
Abstract Background: Leptospirosis is a public health issue caused by the Leptospira bacterium, leading to significant economic impacts.
The cost of illness due to Leptospirosis encompasses hidden costs that significantly affect individuals and society Aims: This study aimed to assess the hidden economic burden .
irect and indirect cost.
experienced by patients and their families due to healthcare treatment of leptospirosis.
Methods: This descriptive cross-sectional study was conducted in Banyumas Regency from February to June 2024.
Data were collected from patients who completed leptospirosis treatment in 2023.
The variables of cost were categorized into direct treatment cost, treatment cost, and indirect cost, which were analyzed descriptively.
Results: Most leptospirosis patients were male, aged 26 Ae 45 years old, and the majority worked as farmers.
Our study reveals that uninsured patients incurred higher out-of-pocket expenses during leptospirosisAo treatment.
The productivity loss was estimated at USD 44.
75, with significant hidden costs being transportation (USD 31.
, caregiver support (USD 86.
, and hospital treatment (USD 231.
Conclusion: The significant burden of Leptospirosis in Indonesia highlights the economic impact on individuals and the challenges within the healthcare system.
This study calls for enhanced public health strategies focused on prevention, early diagnosis, and improved healthcare access to address the leptospirosis burden effectively.
Keywords: Cost of illness, economic burden, financial impact, leptospirosis, productivity loss.
Abstrak Latar Belakang: Leptospirosis merupakan masalah kesehatan masyarakat yang disebabkan oleh bakteri Leptospira, dan berdampak secara ekonomi.
Kerugian ekonomi akibat leptospirosis mencakup biaya tersembunyi yang memengaruhi individu dan masyarakat.
Tujuan: Penelitian ini bertujuan menghitung beban ekonomi tersembunyi yang dialami pasien dan keluarganya akibat pengeluaran medis serta dampak finansial dari pengobatan leptospirosis.
Metode: Penelitian deskriptif dengan pendekatan potong lintang ini dilakukan di Kabupaten Banyumas pada FebruariAeJuni 2024.
Data dikumpulkan dari pasien yang telah menyelesaikan pengobatan pada 2023.
Biaya dikategorikan menjadi biaya langsung, pengobatan, dan tidak langsung, lalu dianalisis secara deskriptif.
Hasil: Mayoritas pasien adalah laki-laki, dan sebagian besar biaya pengobatan ditanggung Jaminan Kesehatan Nasional.
Namun, pasien tanpa asuransi mengeluarkan biaya pribadi lebih tinggi.
Rata-rata kehilangan produktivitas sebesar USD 44,75.
Biaya tersembunyi utama meliputi transportasi (USD 31,.
, pendampingan (USD 86,.
, dan perawatan rumah sakit (USD 231,.
Kesimpulan: Dampak akibat leptospirosis di Indonesia, signifikan berdampak pada individu dan merupakan tantangan untuk sistem pelayanan kesehatan.
Penelitian ini menyarankan untuk meningkatkan strategi kesehatan masyarakat yang berfokus pada pencegahan, peningkatan diagnosis sedini mungkin, dan meningkatkan akses pelayanan kesehatan untuk menurunkan beban leptospirosis secara efektif.
Kata kunci: Beban ekonomi, dampak finansial, kehilangan produktifitas , kerugian ekonomi, leptospirosis.
Indonesian Journal of Health Administration (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301.
Volume 13 No.
DOI: 10.
20473/jaki.
Received: 2025-03-23.
Revised: 2025-06-26.
Accepted: 2025-07-04.
Published: 2025-07-15.
Published by Universitas Airlangga in collaboration with Perhimpunan Sarjana dan Profesional Kesehatan Masyarakat Indonesia (Persakm.
Copyright .
2025 Wahyu Pudji Nugraheni.
Sinta Dewi Lestyoningrum.
Indah Pawitaningtyas.
Syarifah Nuraini.
Linta Meyla Putri.
Ristiyanto.
Carine Milcent.
This is an Open Access (OA) article under the CC BY-SA 4.
0 International License .
ttps://creativecommons.
org/licenses/by-sa/4.
0/).
How to cite:
Nugraheni.
Lestyoningrum.
Pawitaningtyas.
Nuraini.
Putri.
Ristiyanto, and Milcent.
The Hidden Economic Burden of Leptospirosis: Healthcare Costs and Patient Impact.
Indonesian Journal of Health Administration, 13.
, pp.
98Ae109.
doi: 10.
20473/jaki.
The Hidden EconomicA Nugraheni.
Lestyoningrum.
Pawitaningtyas Nuaraini.
Putri.
Ristiyanto.
Milcent Indonesian Journal of Health Administration Original Research (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
Dissanayake, 2.
A study indicated that the global productivity cost of leptospirosis was estimated at approximately USD 29.
billion, with potential high estimates reaching USD 52.
3 billion in 2019.
This highlights the significant economic burden of lost productivity, particularly in lowermiddle-income countries like Indonesia, where the disease is prevalent (Agampodi.
Gunarathna.
Lee, et al.
, 2.
Despite its considerable presence.
Indonesia's overall illness burden needs to be better studied.
Quantifying the burden is critical for effective prevention and control efforts (Saizan et al.
, 2.
Precise data on the distribution of cases, productivity loss estimation, and the cost of treatment remain critically needed inputs to shape effective public health interventions.
Understanding the actual burden of the disease will be necessary for effective public health planning and resource allocation (Munoz-Zanzi et al.
, 2.
However, the study that focused on the economic impact of leptospirosis in Indonesia was uncommon.
The findings of this study are expected to raise awareness among policymakers about the need for targeted interventions and more substantial public health investment.
As a result, this research is critical to the overall improvement of Indonesia's health-care This study aims to assess the hidden economic burden experienced by patients and their families during leptospirosis treatment.
Introduction One of the severe public health issues in Indonesia is Leptospirosis.
The causative agent of this infection is a bacterium known as Leptospira, which can be transmitted to humans and other Its transmission is facilitated by a tropical climate, frequent flooding, and a highly dense population where water contaminated by urine from infected animals is usually present.
Indonesia is estimated to have an annual morbidity of 2 leptospirosis cases per 100,000 However, this ailment is usually missed due to its vague signs and symptoms and lack of diagnostic facilities.
Research involving more than 1,500 febrile patients showed that about three-point-five percent had acute infections with underdiagnosis for numerous individuals suffering from such illnesses (Gasem et al.
Central Java province alone accounts for 36.
1% of Indonesia's leptospirosis cases (Sukendra et al.
, 2.
Indonesia's environment create ideal conditions for spreading this zoonotic disease (Husni.
Martini, and Suhartono, 2.
It is mainly contaminated water, soil, or food and the urine of infected animals.
The economic impact of leptospirosis extends far beyond medical bills, encompassing a range of hidden costs that significantly affect individuals and society.
The spread of leptospirosis also has indirect effects on public health by increasing absenteeism from work and school, and contributing to long-term disability among survivors.
The significant impact on patients as individuals may also suffer long-term complications like chronic kidney disease, contributing to ongoing disability and lost productivity.
While the exact financial burden is not quantified, the high incidence, severe complications, and diagnostic challenges of leptospirosis likely impose a substantial economic burden on Indonesia as social impacts (Ehelepola.
Ariyaratne and The Hidden EconomicA Method This descriptive cross-sectional study was conducted in Banyumas Regency.
Central Java Province.
Indonesia, from February to June 2024.
Central Java leptospirosis cases in Indonesia in 2023.
According to the Health Profile of Central Java Province.
Banyumas Regency was one of the top five regencies in Central Java that reported the highest number of cases of leptospirosis from 2019 to 2023.
The population of this study was all patients in Banyumas Regency who had been diagnosed with leptospirosis.
patients were eligible based on the Nugraheni.
Lestyoningrum.
Pawitaningtyas Nuaraini.
Putri.
Ristiyanto.
Milcent Indonesian Journal of Health Administration Original Research (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
inclusion criteria.
The sample size was determined using the Slovin formula with a 5% margin of error, considering time and human resource constraints.
The inclusion criteria were patients with ICD.
10 code for leptospirosis who had been treated in 2023 and lived in Banyumas Regency during the study.
total of 40 patients who met the inclusion criteria were interviewed between March and May 2024.
A structured interview was performed in this study.
The data were grouped into three main variables: .
direct patient costs, including transportation, selfmedication, and other additional treatmentrelated expenses.
indirect costs, communication costs.
treatment costs, referring to total hospital care expenses.
The cost components were analyzed formulation (Drummond et al.
, 2.
It was assessed individually and averaged to estimate the financial burden.
Additionally, this study calculated productivity losses, defined as the total number of workdays lost due to illness multiplied by the patient's daily wage (Drummond et al.
, 2.
The patientAos daily wage was obtained from the Banyumas district demographic data.
This study also examined the Average Length of Stay (ALOS) among leptospirosis patients, comparing those covered by health insurance and those paying out-of-pocket.
The ALOS number was pivotal in examining social cost due to The formulation of social cost is multiplied by ALOS, prevalence rate, (Drummond et al.
, 2.
The prevalence rate and number of communities in 2023 were performed to estimated it.
elementary school.
Furthermore, most households' incomes .
5%) are below the Banyumas minimum wage (IDR 2,287,572 or USD 150,.
Demographic factors like age, gender, and occupation also influence leptospirosis risk.
Adults aged 20-50 are the most affected group, comprising 58.
of cases in Rio Grande do Sul.
Brazil (Teles et al.
, 2.
Due to occupational exposure and less cautious behavior, men are more frequently infected, particularly those in high-risk jobs like agriculture (Petrakovsky et al.
, 2.
Understanding these factors helps target public health interventions and resources effectively.
Geographic and demographic factors further complicate measuring the burden of Leptospirosis in Indonesia.
The country's diverse environments affect transmission dynamics, including urban and rural areas with varying conditions (Dhewantara.
Riandi, and Wahono, 2.
Regions prone to flooding and poor sanitation see higher disease incidence, while occupational exposure differences, such as among farmers and waste management workers, increase infection risks (Widawati et al.
Urban and rural areas show significant disparities in leptospirosis incidence and risk factors.
Urban outbreaks are often linked to poor living conditions, such as proximity to contaminated water and rodent infestations (Ilma.
Martini, and Raharjo, 2.
In rural areas, infection rates can be up to eight times higher, especially among agricultural workers and those in livestock-related occupations, who face greater exposure to infected soil, water, and animals (Hernandez-Rodriguez.
Gymez, and Villamil, 2017.
Galan et al.
Rural areas have a consistent yearround risk due to ongoing agricultural activities, while urban outbreaks are more seasonal, often after floods (Kembhavi.
Velhal, and Shah, 2.
Measuring Leptospirosis in Indonesia faces significant challenges, primarily due to underreporting and misdiagnosis, as well as a lack of standardized data collection methods.
Underreporting occurs because many healthcare providers are unaware of the Result and Discussion Table 1 presents the demographic and socio-economic characteristics of respondents from Banyumas District.
The population is predominantly male .
%) and aged between 26 and 45.
The majority of participants are covered by National Health Insurance or JKN (Jaminan Kesehatan Nasiona.
5%), and most of the respondents .
%) had completed The Hidden EconomicA Nugraheni.
Lestyoningrum.
Pawitaningtyas Nuaraini.
Putri.
Ristiyanto.
Milcent Indonesian Journal of Health Administration Original Research (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
Table 1.
Characteristics of Respondents in the Banyumas District in 2023
Variable Sex
Male
Female Age Groups 16 Ae 25
26 Ae 35
36 Ae 45
46 Ae 55
56 Ae 65
>= 65
Health Insurance Status JKN (Indonesian National Health Coverag.
Out of pocket Educational Background No formal education Elementary school Junior high school Senior high school Job Farm Worker Housewives Students Gardener Farmer Coconuts Sap Tapper Entrepreneur Others informal job Household income per month < Banyumas minimum wage > Banyumas minimum wage Source: Primary data disease's prevalence and symptoms, often mistaking leptospirosis for other febrile illnesses infection (Sriyani et al.
, 2.
This leads to delays in treatment and worsened clinical outcomes.
Furthermore, leptospirosis shares symptoms with other infections, making it challenging to identify.
The need for better diagnostic tools and professionals is crucial to addressing this issue (Md-Lasim et al.
, 2.
Another major obstacle is the inconsistency in data collection methods The Hidden EconomicA across different regions.
The Indonesian healthcare system requires to implement a standardized method for an integrated data that ensures proper vigilance and subsequent response strategies (Eka Purnama and Hartono, 2.
The healthcare system lacks standardized diagnostic and reporting mechanisms, which affects the efficiency of surveillance and response efforts (Yuniasih et al.
, 2.
Table 2 compares the health expenditures for leptospirosis patients covered by national health coverage or JKN insurance and patients without Nugraheni.
Lestyoningrum.
Pawitaningtyas Nuaraini.
Putri.
Ristiyanto.
Milcent Indonesian Journal of Health Administration Original Research (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
Transportation barriers are essential to access health services, especially for those with low incomes or without insurance/ insurance (Samina T.
Syed.
Ben S.
Gerber.
Leptospirosis inpatients in the Banyumas District use varied modes of most patients use public transit, motorbikes, cars, or ambulances owned by health centers.
The study accessible modes of transportation varies according to the level of public transportation infrastructure (Jang.
Seon, and Oh, 2.
The majority of insurance patients were treated in hospitals that were at home due to the insurance regulations.
Conversely, out-of-pocket patients have varied options when selecting a hospital for the leptospirosis treatment.
Our study reveals that the type of hospital .
ublic or privat.
tended to perform at a high cost.
Thereafter, the insurance patients were likely to spend more money compared to out-of-pocket patients.
Along with the majority of the insurance, patients experienced the over-the-counter drug, and/or traditional remedies called jamu and/or massage before they sought medical care.
It was related to the statement of the Indonesia Central Bureau of Statistics that most of the community .
%) engaged in self-medication (Badan Pusat Statistika, 2.
Most citizens relied on traditional medicine due to accessibility and affordability (Widowati and Nurhayati.
Research conducted in Kudus Regency revealed that the education and knowledge of the patients influenced their self-medication behavior (Ferika Indrasari.
Eleonora Maryeta Toyo.
Siti Munawaroh.
In more detail, decision-makers in family and health information affected the decision to self-medicate (Rauf et al.
, 2.
Table 2 compares healthcare costs for JKN (Indonesia's national health insuranc.
and general patients, covering various medical services and treatments.
highlights the minimum, maximum, and average costs for both groups.
The cost medications, doctor consultations, medical insurance .
ut-of-pocket patient.
The direct costs for insurance patients were performed as additional medical treatments not covered by national health coverage, transportation costs, and self-medication.
Table 2 shows that the results for all those costs were relatively low.
The details were medical treatments at an average of USD 63, transportation at USD 8.
81, and selfmedication at USD 3.
Then, the indirect costs for the insurance patient were expenses on average for caregivers (USD .
and average communication costs (USD 1.
Conversely, the direct costs for outof-pocket patients included the average transportation costs (USD 31.
and the average self-medication (USD 2.
Meanwhile, the average number of caregiver costs for out-of-pocket patients was USD 86.
38, and the average number of communication costs was USD 2.
This study reveals significant cost differences between those covered by the National Health Insurance and out-ofpocket patients.
Both groups incurred high expenses, with indirect costs, mainly caregiver expenses .
ccommodation, food, transportatio.
, being the largest.
Transportation and food dominated caregiver costs.
Sabermahani et al.
that nonmedical costs doubled the hospital (Sabermahani et al.
, 2.
Transportation posed a financial burden, especially for rural patients needing to travel to urban facilities (Yuan.
Zhang, and Li, 2022.
Thomson et al.
, 2.
The family of leptospirosis patients faced high transportation costs due to the distance to reach the hospital, often incurring more costs than the patients themselves.
On the side, the caregivers also faced significant consumables such as food or drink expenses while waiting for patients, especially when multiple family members accompanied them.
Research reveals that longer hospital stays lead to increased caregiver food expenses (Destanul Aulia.
Sri Fajar Ayu, 2.
The results also reveal the high costs patients and their families expended during the treatment.
The average transportation cost of out-of-pocket patients was three times that of insurance patients.
The Hidden Economic.
Nugraheni.
Lestyoningrum.
Pawitaningtyas Nuaraini.
Putri.
Ristiyanto.
Milcent Indonesian Journal of Health Administration Original Research (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
and nonmedical examinations, inpatient medical procedures, and hemodialysis.
To summarize, the insurance patients performed the average total cost at USD 226.
46, which is cheaper compared to the total cost of out-of-pocket patients (USD The result showed that the drug and accommodation indicated the highest cost during the treatment of Leptospirosis in Banyumas.
The insurance patients reported the highest cost at USD 346.
the average cost was USD 65.
72 for drugs and other medical consumables.
Table 2.
The Cost Components of Leptospirosis Patients during Treatment in Banyumas Regency, 2023 Minimum Maximum Average Cost Component Cost (USD) Cost (USD) Cost (USD) National Health Insurance Patients Direct Costs Additional medical treatment costs .
ot covered by NHI) Transportation Self-medication Indirect Costs Caregiver cost Communication Treatment cost Length of Stay .
n day.
3 days 20 days 7 days Laboratory Drug and other stuff medical Professional cost Procedural cost .
urgical and non18.
Medical Support Cost Nonmedical Support Cost Inpatient Accommodation Emergency Room Accommodation Haemodialysis Intensive Care Service Total Out-of-Pocket Patients Direct Costs Transportation Self-medication Indirect Costs Caregiver cost Communication Treatment Cost Length of Stay .
n day.
3 days 20 days 7 days Laboratory Drug and other medical consumables Professional cost Procedural cost .
urgical and non18.
Medical Support Cost The Hidden Economic.
Nugraheni.
Lestyoningrum.
Pawitaningtyas Nuaraini.
Putri.
Ristiyanto.
Milcent Indonesian Journal of Health Administration Original Research (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
Minimum
Cost (USD) Cost Component Nonmedical Support Cost
Inpatient Accommodation Emergency Room Accommodation Haemodialysis Intensive Care Service Total
Maximum
Average Cost (USD) Cost (USD) Source: Primary Data
1 USD = IDR 15,241
Table 3.
The Opportunity Cost and Cost of Illness of Leptospirosis Patients in Banyumas Regency, 2023 Opportunity Cost Number of Opportunity Cost Component Average of (ALOS X References minimum wag.
UninsuranceAos Patient Average Length of Stay 7th days USD 40.
Average Daily Minimum Wage USD 6.
effective working day.
National Health Insurance Patients Average Length of Stay 9th days USD 44.
Average Daily Minimum Wage USD 6.
effective working day.
Disparity USD 3.
Cost of Illness
USD 464,01
Source: Primary Data
1 USD = IDR 15,241
On the other hand, patients who were uncovered by insurance recorded drugs and other stuff medical consumables with an average of USD 70.
63 and USD 243.
as the highest records during leptospirosis The leptospirosis treatment in hospitals slightly differs between national health insurance and out-of-pocket patients.
Out-of-pocket patients were likely more expensive compared to insurance patients.
Delays in diagnosing leptospirosis infections and hospitalization lead to patientAos Leptospirosis symptoms are likely to be similar to those of influenza, dengue fever, and other viral hemorrhagic infections.
influenced the doctors in diagnosing the patient with leptospirosis.
Meanwhile, patients who have been diagnosed with leptospirosis lately might require intensive Furthermore, healthcare is associated with high expenditure due to a high total cost of Leptospirosis The Hidden Economic.
significant workdays lost due to illness and long-term disability.
Leptospirosis patients experience a wide range of debilitating symptoms, starting with fever and In addition, some of the patients experienced severe complications like kidney or liver damage, which required intensive medical care.
They risked being unable to work or perform daily tasks during treatment, bed rest, and some medical procedures (Agampodi.
Gunarathna.
-S.
Lee, et al.
, 2.
Hence, this illness also brings substantial financial losses for individuals and families.
Table 3 presents the opportunity cost for both insurance (Indonesian National Health Insuranc.
and out-of-pocket patients, which is examined based on the average length of stay in the hospital and the daily minimum wage.
The average length of stay of insurance patients was 7 days, which led to the estimation of opportunity cost at USD 40.
out-of-pocket recorded an average length of stay of 9th Nugraheni.
Lestyoningrum.
Pawitaningtyas Nuaraini.
Putri.
Ristiyanto.
Milcent Indonesian Journal of Health Administration Original Research (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
campaigns to reduce the cost of Engaging management can enhance these efforts, minimizing transmission and reducing the financial burden on healthcare systems (Widawati et al.
, 2.
Strengthening systems of leptospirosis is essential to ensure adequate diagnosis and response to outbreaks.
Following that, collaborative efforts to improve sanitation and emergency preparedness are keys to preventing leptospirosis in endemic areas (Sykes et al.
, 2.
Rapid diagnostic tests are critical for early detection.
However, obstacles to availability lead to delayed treatment, which increases the risk of high costs.
Therefore, ensuring access to these tests and advanced treatments can reduce long-term healthcare costs and improve patient outcomes (Rajapakse, 2.
Mobile health applications and telemedicine platforms can enhance case tracking and elevate treatment management and resource allocation.
The application can assist in calculating treatment costs and economic losses, providing a clearer understanding of the financial impact of leptospirosis and guiding more effective resource distribution (Petakh et al.
, 2.
days, and the result showed the opportunity cost at USD 44.
Table 3 also depicts the average Cost of Illness (COI) due to leptospirosis.
It was USD 464.
01 in economic losses due to leptospirosis during 2023.
The cost includes the hospital treatment and the amount of non-treatment expenses the patient must incur.
The other study conducted in Banyumas found that the cost of illness due to leptospirosis, obtained from health facilitiesAos vision, was reported at USD 289.
64 in 2021 (Nugraheni et al.
Another study in New Zealand found that the average loss due to Leptospirosis was USD 4.
42 million.
These figures included the losses due to absenteeism, medical expenses, and treatment until recovery (Sanhueza et al.
, 2.
The amount of therapy and other patient costs are consequences of the cost of illness.
Although the cost of treatment in a healthcare facility was covered by insurance, different direct and indirect costs were not covered by the insurance payment.
Furthermore, estimated the social cost due to leptospirosis in 2023.
This study performed the average length of stay (ALOS) of all leptospirosis patients at 8 days.
Then, the prevalence rate of leptospirosis in 2023 96%, and the population of Banyumas Regency was 1,828,573.
The formulation of social cost is multiplied by ALOS, prevalence rate, minimum wage, and population (Drummond et al.
, 2.
a result, the social cost lost due to Leptospirosis in Banyumas amounts to USD 6,068.
79 per month.
Productivity losses rose from the patientAos inability to work and family members who may need to take time off to provide care (Agampodi.
Gunarathna.
Lee, et al.
, 2.
Long-term complications can lead to further loss of productivity and financial strain, impacting households and the broader workforce.
Additionally, the burden on healthcare resources and societyAos overall quality of life is significant when the disease is not adequately managed (Wang et al.
, 2.
Public health strategies must emphasize prevention through surveillance The Hidden Economic.
Conclusion In conclusion, this study highlights the significant burden of Leptospirosis in Indonesia, emphasizing both its economic toll on individuals and the systemic challenges within IndonesiaAos healthcare The demographic data shows that leptospirosis predominantly affects males, especially in agricultural and rural conditions and occupational exposure increase the risk of infection.
The analysis of healthcare costs reveals substantial financial strain due to hospitalization and indirect caregiving costs, particularly for those uninsured or dependent on public healthcare programs like JKN.
With significant costs and productivity losses, leptospirosis affects Nugraheni.
Lestyoningrum.
Pawitaningtyas Nuaraini.
Putri.
Ristiyanto.
Milcent Indonesian Journal of Health Administration Original Research (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
individuals, households, and the wider Thus, the results of this study could be an evidence for the authority to ensure the health allocation for better healthcare especially for leptospirosis in endemic areas in Indonesia.
Whereupon, this result plays a role as first stage of the health economic evaluation for healthcare systems and the implementation of universal health coverage in Indonesia.
This study addressed the limitations of retrospective recollections of patients' and caregivers' responses due to the total costs, and the small sample size.
All eligible patients were interviewed about their treatment-related expenses.
However, discrepancies arose when patients and caregivers argued over the total cost of their treatment.
To help recall these out-ofpocket costs, we used the price of gasoline and the distance from their homes to healthcare facilities .
rimary care centers or hospital.
to remind them.
Consequently, unnecessarily incorporated bias by being Notwithstanding these constraints, the results offer practical and realistic data on the economic costs to households of The magnitude of this economic impact is poorly documented in Indonesia, and the present study thus contributes to filling this gap, potentially enabling public policy.
This study suggests that future studies should consider DALYs as a target outcome to study (Lost years of life deaths specifically and years spent living with the disease (Kim et al.
, 2.
Hitherto, research that examines DALYs related to leptospirosis is uncommon in Indonesia.
Consequently, an expanded inquiry across a broader geographic area must be conducted to enhance the existing data.
Notwithstanding the limitation, our findings emphasize the impact of leptospirosis on human productivity and the burden it inflicts on households.
The preventive measures and the promotion and prevention of the leptospirosis control program require an improvement to mitigate the outcome effectively.
Finally, this study recommends that the local government of Banyumas The Hidden Economic.
Regency and Central Java Province develop a strategy to decrease the occurrence of severe cases of leptospirosis.
Nationally, this study advocates for enhanced public health strategies focusing on prevention, early diagnosis, and improved healthcare access to address the leptospirosis burden effectively.
Key comprehensive vaccination programs, improving sanitation, and conducting public awareness campaigns are essential to Strengthening disease surveillance and ensuring access to rapid diagnostic tools will enable timely interventions, ultimately lowering the overall healthcare costs associated with leptospirosis.
Abbreviations DALYs: Disability-adjusted life years.
JKN: Jaminan Kesehatan Nasional.
WHO:
World Health Organization.
GDP: Gross Domestic Product.
MoH: Ministry of Health.
IDR:
Indonesian Rupiah.
ICD.
International Statistical Classification of Diseases 10th revision.
USD: United States Dollar.
Declarations Ethics Approval and Consent Participant The study was conducted by the Ethical Approval for Study and approved by the National Research and Innovation Agency Health Ethics Commission.
Republic of Indonesia, 042/KE.
03/SK/05/2023, approval date May 2nd, 2023.
Conflict of Interest The authors declare that they do not have a conflict of interest.
Availability of Data and Materials The author cannot publicly disclose the data since neither a third party nor the Banyumas Regency and researchers, the data's owner, are authorized to do so.
AuthorsAo Contribution Conceptualization:
WPN
SDL.
Methodology: SDL and IP.
Software:
Nugraheni.
Lestyoningrum.
Pawitaningtyas Nuaraini.
Putri.
Ristiyanto.
Milcent Indonesian Journal of Health Administration Original Research (Jurnal Administrasi Kesehatan Indonesi.
p-ISSN 2303-3592, e-ISSN 2540-9301 20473/jaki.
Microsoft Excel version 16.
89: SDL.
and LMP.
Formal analysis: SDL and IP.
Investigation: WPN.
CM.
SDL.
Resources:
SDL.
Data curation: SN and IP.
Writing original draft preparation: WPN.
SDL.
IP.
SN, and LMP.
Writing review and editing:
SDL.
SN.
LMP.
IP.
Visualization: R and SN.
Supervision: WPN and CM.
All authors have read and agreed to the published version of the manuscript.
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AoImplications Funding Source National Research and Innovation Agency of the Republic of Indonesia (BRIN) Acknowledgment The authors thank the National Research and Innovation Agency of the Republic of Indonesia for providing grants and funding for this research.
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