Economic Burden of Oral Cancer and Resource-Stratified Approach to the Management of Gingivobuccal Cancers.

EXECUTIVE SUMMARY Oral cancer is the term described as cancers occurring in the mouthparts that include lips, cheeks, sinuses, tongue, hard and soft palate, or the base of the mouth extending up to the oropharynx. Globally, oral cancer ranks 17th among all types of cancer in terms of both incidence and mortality. India has the largest number of oral cancer cases in the world, and this constitutes more than one-third of the total global burden. In India, oral cancer ranks as the second most common cancer, and is the number one cancer among males. In India, around 130,000 new cases and >75,000 deaths were reported only in the year 2020, with an expected doubling of incidence by 2040. This burden of oral cancer is further complicated by the late-stage diagnosis and low survival rates. In India, the majority of oral cancer cases are reported in the advanced stages, and hence, the chances of cure are very low. This report provides an insight into oral cancer as a public health problem in India, along with etiology and strategies to diagnose, treat, and prevent it while providing recommendations to improve upon the availability and delivery of treatment for oral cancer. The predominant risk factor for developing oral cancer is tobacco consumption. The continual use of tobacco in both smoking and smokeless forms is a major contributor to tumor development in the oral cavity. Other risk factors such as alcohol, diet and nutrition, oral thrush, dental problems, chronic irritation from sharp teeth or ill-fitting dentures, and human papillomavirus (HPV) infection also contribute to the burden. Further, social, cultural, and psychological factors too play an important role in developing oral cancer. Oral potentially malignant disorders (OPMDs) are a diverse group of conditions that are the precursors of oral cancer. It is important to recognize that a patient diagnosed with an OPMD has an increased risk of developing oral cancer compared to a person with a healthy mucosa. Lesions such as Erythroplakia, Erythroleukoplakia, Leukoplakia, Proliferative verrucous leukoplakia, Submucous fibrosis, Palatal lesions associated with reverse smoking, oral lichenoid lesions, oral lichen planus, smokeless tobacco keratosis, and more are the common OPMDs seen in the country. Oral cancer screenings, which are conducted to identify any clinical premalignant phase (accessible to visual inspection), are usually done on a mass scale and shows a decreased burden of advanced oral cancer incident cases and deaths as compared to no screening. Among the screening strategies, it is suggested that high-risk screening is cost-effective compared to mass screening at periodic intervals. Oral cancer screening methods vary across healthcare settings, each with its advantages and limitations. While visual inspection remains a fundamental tool, adjunctive technologies are sometimes used in dental clinics; community outreach programs and telemedicine extend accessibility to screening. The Ministry of Health and Family Welfare, Government of India, has prepared a universal and objective operational framework for cancer screening and management that aims to promote, coordinate, and conduct research to better understand, detect, diagnose, and treat cancer. The framework makes it mandatory to perform screening of oral, cervix, and breast cancer for males and females above the age of 30. Concerning oral cancer treatment, several modalities are available; however, the cure depends on the cancer stage when diagnosed and the delay in starting treatment. Primary surgery is the preferred modality of treatment for a vast majority of operable oral cancers. Radiotherapy is an alternate for early-stage oral cancers with comparable control rates to surgery. Typically, the primary treatment for oral cancer is surgery. The primary goal of surgical resection is to ensure complete removal of the tumor tissue. However, the potential negative impacts on appearance and functionality due to the extent of the disease and the necessary surgical removal stress the importance of using less invasive surgical methods. The National Cancer Grid Management Guidelines for early-stage cancer recommends surgical local excision with a minimum of 1 cm gross margin, accompanied by appropriate neck dissection and suitable reconstruction. For advanced stages, surgery is preferred, along with adjuvant radiotherapy or chemotherapy. Oral cancer in its entirety imposes a significant fiscal burden on a national, institutional, family, and individual level. Funding of cancer care in India is a complex mixture of state and government accountabilities, with the government shouldering most of the responsibility. Oral cancer as such, has not been given a separate budget in India, but it is covered under various facilities of the government, schemes, and programs for cancer. This report entails the Task Force Committee recommendation for screening, diagnosis, prevention, and management of oral cancer, along with research, policy, and advocacy recommendations to address this immense public health problem in the country.

Oral cancer including lip, oral cavity cancer contributes to cancer burden importantly in the world. It is crucial for effective policy planning to comprehensively evaluate oral cancer burden regionally. The incidence, mortality, and disability-adjusted life years (DALYs) due to oral cancer from 1990 to 2021 were estimated according to Global Burden of Disease (GBD) 2021 methods. The GBD comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for oral cancer attributable to smoking, tobacco, and alcohol consumption in 2021. The male-to-female ratio of age-standardized incidence rate (ASIR) for oral cancer was 2.99 in China, 2.7 in Europe, 2.24 in the United States, 1.73 in Southeast Asia, and 1.51 in Africa. The corresponding ratios of age-standardized mortality rate (ASMR) for oral cancer were 3.82, 3.16, 2.45, 1.89, and 1.60 respectively. Key risk factors for oral cancer-related deaths and DALYs varied by region and showed distinct age- and sex-stratified patterns. In China, tobacco was the primary contributor, accounting for 51.4% of oral cancer deaths in men, with a higher impact among older males aged ≥ 55 years. In Europe and the United States (US), alcohol consumption dominated, contributing a larger proportion of deaths in younger men (20-54 years) and showing higher attributable fractions than smoking in these age groups. In Southeast Asia, chewing tobacco was the major driver, responsible for 48.79% of oral cancer deaths in women, with this proportion exceeding 50% in females aged ≥ 55 years. Among men in Southeast Asia, smoking was the predominant risk factor for oral cancer mortality. The burden of oral cancer exhibits distinct temporal and regional variations, with significant differences in incidence, mortality, and DALYs across global regions. Such differences are strongly associated with region-specific risk factor patterns, and these patterns also vary by age and sex. These insights highlight the need for targeted prevention strategies tailored to regional, age, and sex characteristics, including anti-smoking interventions in older Chinese men, alcohol control measures in younger European and American men, and efforts to reduce chewing tobacco use among older Southeast Asian women, to effectively mitigate the global burden of oral cancer.

ObjectiveThis study aims to examine the temporal Trends in the burden of lip and oral cavity cancer in China from 1990 to 2021, stratified by age and sex. Key indicators—including prevalence, incidence, mortality, and disability-adjusted life years (DALYs)—are analyzed and compared with corresponding global metrics.MethodsUsing data from the Global Burden of Disease (GBD) database spanning 1990 to 2021, we conducted a systematic analysis of trends in the burden of lip and oral cavity cancer in China and worldwide. The average annual percent change (AAPC) was estimated using Joinpoint regression analysis to quantify the magnitude of temporal trends. Differences in cancer burden across age groups and sexes were evaluated, and the ARIMA model was employed to project future trends. Finally, we conducted a decomposition analysis to determine the percentage contribution of factors affecting the burden of lip and oral cancer.ResultsFrom 1990 to 2021, the age-standardized incidence rate (ASIR) of lip and oral cavity cancer in China increased from 1.704 to 2.681 per 100,000 population, while the global ASIR rose from 4.270 to 4.880 per 100,000. The age-standardized prevalence rate (ASPR) in China increased from 4.168 to 10.158 per 100,000, compared to a rise from 13.888 to 17.706 per 100,000 globally. The age-standardized mortality rate (ASMR) in China declined from 1.224 to 1.152 per 100,000, while the global ASMR decreased slightly from 2.454 to 2.424 per 100,000. The age-standardized disability-adjusted life years rate (ASDR) in China fell from 32.086 to 29.205 per 100,000, whereas the global ASDR decreased from 69.266 to 67.714 per 100,000. Between 1990 and 2021, the average annual percent changes (AAPCs) in China were 1.487% for ASIR, 2.899% for ASPR, − 0.187% for ASMR, and − 0.319% for ASDR. In comparison, the corresponding global AAPCs were 0.443%, 0.796%, − 0.029%, and − 0.072%, respectively. Age and sex had a significant impact on the burden of lip and oral cavity cancer, with males consistently exhibiting higher incidence, prevalence, mortality, and DALYs than females. Projections for the next 15 years indicate that the ASIR and ASMR in China will likely stabilize, while the ASPR and ASDR are expected to continue increasing. Globally, the ASMR and ASDR are projected to remain stable, whereas the ASIR and ASPR are anticipated to rise. The decomposition analyses revealed that both population aging and population increase factors exacerbated the burden of lip and oral cancer, whereas epidemiologic changes promoted the number of lip and oral cavity cancer cases but suppressed the increase in the number of deaths and DALYs.ConclusionFrom 1990 to 2021, the incidence and prevalence rates of lip and oral cavity cancer increased in both China and globally, while mortality and disability-adjusted life years (DALYs) experienced a slight decline. The burden of the disease was strongly associated with sex and age, with males exhibiting significantly higher incidence, prevalence, and mortality rates than females, and older adults demonstrating substantially higher rates compared to younger age groups. Over the next 15 years, the prevalence and DALY burden in China are projected to increase, while global incidence and prevalence are also expected to rise. Given China’s rapidly aging population, these findings highlight growing public health challenges that call for sustained, coordinated efforts to mitigate the future burden.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-025-06839-w.

Lip and oral cavity cancers are among the top 10 cancer causes and mortality globally. Some countries in the Indian subcontinent bear a disproportionately higher burden of lip and oral cavity cancers. Detailed analysis of lip and oral cavity cancers in the Indian subcontinent using all available data is important for effective policy planning. This paper aims to summarise the total burden of lip and oral cavity cancer and compare it across countries within the Indian subcontinent. Data from the Global Cancer Observatory (GCO) and Global Burden of Disease (GBD) Study were extracted to analyse cancer incidence, prevalence, mortality and cancer risk before reaching 74 years. Furthermore, summary estimates of years of life lost (YLL), years lived with disability (YLDs) and disability-adjusted life years (DALYs) attributable to lip and oral cavity cancers were extracted from the GBD database. The data of individual countries within the Indian subcontinent were used for comparison. The estimated number of deaths from lip and oral cavity cancers for 2019 was 90732 in the Indian subcontinent. The Indian subcontinent accounted for 45.3% of the deaths attributable to lip and oral cavity cancers. The incidence of lip and oral cavity cancers in the Indian subcontinent ranged from 3.18 per 100,000 population in Maldives to 12.76 per 100,000 population in Pakistan. The incidence rate of lip and oral cavity cancer in India was 7.54 per 100,000 population. However, due to the population size, India accounted for 104837 incident cases of lip and oral cavity cancers annually. The estimated number of prevalent and incident cases of lip and oral cavity cancers from the Indian subcontinent in 2019 was 0.46 million (30% of overall cases globally) and 0.15 million (39% of incident cases globally), respectively. The Indian subcontinent also accounted for 50% of the DALYs attributable to lip and oral cavity cancers worldwide. The Indian subcontinent accounts for disproportionately higher cases and deaths due to lip and oral cavity cancers than other regions. It calls for urgent policy action to prevent the disease spread, early diagnosis and optimal management of lip and oral cavity cancers in the Indian subcontinent.

<p class="abstract"><strong>Background:</strong> Head and neck cancers constitute around 5-50% of all cancers worldwide. <sup> </sup>Head and Neck Cancers constitute about 30% of all cancers that are found in India. It is the 8<sup>th</sup> most common cancer in the world. Oral cancer forms a major public health issue in India due to its rising incidence, especially in women and in younger age group. The purpose of our study was to evaluate, the epidemiologic profile of patients with oral cancer, its incidence according to age and sex, site distribution, risk factors involved and clinical stage at presentation.</p><p class="abstract"><strong>Methods:</strong> It is a prospective study done from January 2014 to November 2014, in a total of 100 patients in age group 21 to 70 years, irrespective of gender, with a proven malignancy confined to the oral cavity. Patients were observed for the age and sex distribution, tumour staging, location and<strong> </strong>metastasis, commonly associated risk factor and most common site. </p><p class="abstract"><strong>Results:</strong> Oral cavity cancers were more common in males, than females. It is most prevalent in age group of 51-60 years. Oral tongue is the most common site. Betel nut chewing is the most significant risk factor associated with oral cavity cancer.T1 and T2 is the most the most common primary T stage. Neck metastasis occurs most commonly at N2 stage. Most common neck node level involved is level 2.</p><p><strong>Conclusions:</strong> Oral cancers presents at advanced stage and age. It has also been seen in younger generations, which is due to increasing use of tobacco, its related products and alcohol. We see patient’s reports at advanced age and stage, which is increasing the<strong> </strong>morbidity and mortality related to oral cancers. Hence, today there is great need to create awareness about oral cancers. Preventive strategies must be designed in order to lessen the burden of Oral cancers. </p>

Head and Neck Cancer Incidence, Mortality, and Disability-Adjusted Life Years From 1990 to 2021-A Systematic Analysis for the Global Burden of Disease Study.

Introduction: The oral cavity includes the lips, buccal mucosa, teeth, gingiva, anterior two third of the tongue, the floor of the mouth, and hard palate. Comprehensive data on the burden of oral cancer are lacking at the national and state levels. Therefore, analysing the changing trend in oral cancer in India over the last three decades fills a significant gap. Methods:In this study, the number of new cancer cases, the population at risk, and the crude incidence rate were extracted from the GBD 2019 data. We used the Joinpoint regression to assess the trends in age-adjusted incidence rates per 100,000 population for lip ad oral cancer among men in India from 1990 to 2019 and we used the cancer registry data for the projection of the cancer incidence for all the states, union territories, and India every five years from 2026 to 2036 for lip and oral cancer among men.Results:The estimate of lip and oral cancer cases among Indian men will be 131,414 in 2026, will increase to 147,488 during 2031, and will increase to 163,224 during 2036. Conclusion:The present study estimates the lip and oral cancer cases, which will help for planning purpose of cancer screening facilities for early detection, awareness of cancer, modifying lifestyle, reduction in tobacco use, and establishment of adequate treatment guidelines that can effectively be carried out at different levels (district hospitals, teaching hospitals, specialized hospitals, etc.) would also help in the reduction of mortality due to oral cancer as well as the burden of oral cancer.

In August 1996, CDC convened a national conference to develop strategies for preventing and controlling oral and pharyngeal cancer in the United States. The conference, which was cosponsored by the National Institute of Dental Research of the National Institutes of Health and the American Dental Association, included 125 experts in oral and pharyngeal cancer prevention, treatment, and research; both the private and public sectors were represented. Participants at the conference developed recommendations concerning advocacy, collaboration, and coalition building; public health policy; public education; professional education and practice; and data collection, evaluation, and research. A follow-up meeting consisting of selected participants of the 1996 conference was held in September 1997. During this meeting, changes that had occurred in the political and scientific arenas since the 1996 conference were considered, and 10 recommended strategies from the conference were selected for priority implementation. These 10 strategies were to a) establish a mechanism to implement and monitor the recommended strategies developed during the conference; b) urge oral health professionals to become more actively involved in community health; c) require instruction in preventing and controlling tobacco and alcohol use at all levels of training in dental, medical, nursing, and other related health-care disciplines; d) encourage Medicaid, Medicare, traditional insurance plans, and managed-care entities to consider making oral cancer examinations an integral part of comprehensive physical and oral examinations; e) designate federal funding for a national program of oral cancer prevention, early detection, and control; f) after assessing local needs, develop, implement, and evaluate statewide models to educate all relevant groups; g) develop and conduct a national promotional campaign to raise public awareness of oral cancer and its link to tobacco use and heavy alcohol consumption; h) develop health-care curricula that require competency in prevention, diagnosis, and multidisciplinary management of oral and pharyngeal cancer; i) sponsor and promote continuing education for health-care professionals on the multidisciplinary management of all phases of oral cancer and its sequelae; and j) strengthen organizational approaches to reducing oral cancer by developing organized cooperative and collaborative arrangements, funding formal centers, and involving commercial firms. CDC will use these recommended strategies to develop programs to reduce the burden of oral and pharyngeal cancer in the United States. Through the Oral Cancer Roundtable, a group of conference and meeting participants, CDC will communicate to interested agencies, organizations, and state health departments ways in which they can implement elements of the national plan. The Roundtable will help CDC track the efforts and progress of these groups.

Oral and pharyngeal cancer patients diagnosed at an advanced stage experience increased morbidity and mortality relative to those with localized disease. The aim of this study was to assess the impact of dental insurance status and regularity of dental visits on early detection of oral and pharyngeal cancer. We examined the relationship of dental insurance and frequency of dental visits with stage at diagnosis among 441 oral and pharyngeal cancer cases from a population-based study of head and neck cancer. Ordinal logistic regression models were used to assess the association with stage, and tumor (T) and nodal (N) classification. Never or rarely going to the dentist was associated with being diagnosed at higher stage for oral and pharyngeal cancer (cumulative OR = 2.28, 95 % CI: 1.02-5.10) and oral cancer (cumulative OR = 9.17, 95 % CI: 2.70-31.15) compared to those going to the dentist at least annually. Oral and pharyngeal cancer patients who went to the dentist infrequently (cumulative OR = 1.82, 95 % CI: 1.09-3.05) or rarely/never (cumulative OR = 3.24, 95 % CI: 1.59-6.57) were diagnosed with a higher T classification compared with those who went at least annually. Receipt of regular dental examinations at least annually may reduce the public health burden of oral and pharyngeal cancer by facilitating earlier detection of the disease.

BackgroundHead and neck cancer (HNC) is one of the most prevalent malignant tumors, with higher incidence and mortality rates in men than in women, particularly for lip and oral cavity, nasopharyngeal, laryngeal, and other pharyngeal cancers. This study investigates global trends in the occurrence of these cancers in men from 1990 to 2021 and analyzes their changing trends to guide healthcare policymakers in resource allocation.MethodsUsing data from the 2021 Global Burden of Disease Study (GBD 2021), this study assesses the global prevalence, incidence, mortality, and disability-adjusted life years (DALYs) for male head and neck cancers. It also evaluates the relationship between cancer burden and economic development using the Socio-Demographic Index (SDI) and analyzes the risk factors for male head and neck cancer mortality and DALYs.ResultsFrom 1990 to 2021, the impact of male head and neck cancers increased at varying rates. In 2021, there were 968,573 prevalent cases of lip and oral cavity cancer, 272,917 incident cases, 136,890 deaths, and 3,969,812 DALYs globally. The burden of nasopharyngeal, laryngeal, and other pharyngeal cancers was lower, with 385,913, 939,924, and 258,723 prevalent cases, respectively. The age-standardized incidence rates for all four cancers were positively correlated with the SDI. Key risk factors for male head and neck cancers include smoking and alcohol consumption. Additional risk factors include chewing tobacco for lip and oral cavity cancer deaths, formaldehyde exposure for nasopharyngeal cancer, and occupational exposure to sulfuric acid and asbestos for laryngeal cancer.ConclusionsLip and oral cavity cancer remains the most burdensome, while nasopharyngeal cancer is increasing in East and Southeast Asia. Laryngeal cancer has declined in high-SDI regions, while other pharyngeal cancers are rising. Gender and lifestyle are key risk factors, underscoring the need for early prevention, particularly in resource-limited areas. As the global population ages, targeted prevention and improved healthcare infrastructure are essential.

Objectives: To document the burden of oral cancer in South East Asia (SEA) and to examine the gaps in acquiring accurate data within these countries. Methods: Epidemiological data on oral cancer from countries in SEA were obtained and reviewed from public population-based databases. Descriptions on the incidence and mortality of oral cancer were based on data obtained from GLOBOCAN 2012, and prediction of the number of cases and deaths due to oral cancer were also taken from the same database. The availability of and accessibility to population-based cancer registry were also documented. Results: Five of the eleven countries in SEA have national cancer registries, but the reporting periods varied from 2002 to 2014 across these countries. Whilst incidence and mortality data were obtainable for all SEA countries from GLOBOCAN 2012, data quality varied substantially across the countries. Estimated incidences of oral cancer ranged from 1.6 to 8.6/100,000 per annum with similar rates in males and females for most countries. The incidence was the highest in Myanmar and Brunei for males and females, respectively. Mortality due to oral cancer was reported to be 0.4 to 5.3/100,000, with the highest mortality in Myanmar and Timor-Leste among males and females, respectively. Based on the predicted number of cases and deaths for 2020, oral cancer incidence and mortality is expected to increase and the trends are similar between males and females, which is not surprising as with population growth, the disease burden will rise further. Conclusion: This study demonstrates a severe lack of accurate epidemiological data on oral cancer and underscores the urgent need to develop expertise within this region that can address this issue. While there is a clear need for improved primary prevention, for increased skilled workforce and for improved diagnostic and treatment facilities, an essential first step is to establish robust cancer registries so that progress or lack thereof can be monitored accurately, and appropriate action planned.

A scientometric study of oral cancer research in South and Southeast Asia with emphasis on risk factors control

PURPOSEOral cancer is the sixth most common cancer worldwide and is the seventh most common in Botswana. Lack of improvement in oral cancer survival despite the availability of multiple treatment options may be due to the high prevalence of advanced stage at presentation. We identified risk factors for presenting with oral cancer at an advanced stage to facilitate interventions to reduce mortality from oral cancers.METHODSA retrospective cohort analysis was conducted among individuals with biopsy-confirmed oral cancer at Princess Marina Hospital in Gaborone, Botswana, between 2010 and 2020. Data collected included age at diagnosis, sex, place of residence, HIV status, oral cancer stage, and oral subsite. Multivariable analyses were controlled for age, sex, district of residence, and oral subsite.RESULTSOf the 218 records analyzed, 79% were male, 58% were HIV-positive, the median age was 56 years (interquartile range: 47-63), and 67% presented with advanced-stage disease. Cancers from hidden oral sites were more likely to present at an advanced stage with an adjusted odds ratio (OR) of 2.98 (95% CI, 1.29 to 6.89; P = .01). Residence in socioeconomically disadvantaged districts was associated with higher likelihood (OR, 2.36; 95% CI, 1.28 to 4.39; P = .01) of advanced stage presentation compared with other districts. HIV infection was not associated with risk of advanced lesion presentation (OR, 1; 95% CI, 0.61 to 1.61; P = .97).CONCLUSIONHidden oral cancer sites and residence in districts with limited access to care were risk factors for advanced oral cancer at the time of diagnosis in Botswana. These findings support a need to increase efforts to improve access to care and increase oral cancer awareness to decrease the burden of advanced oral cancer.

IntroductionOral cancer is ranked among the ten most common cancers in the world and is a growing public health concern in Nigeria. However, the extent of the burden of oral cancer in Nigeria is poorly understood. A better understanding of the prevalence of oral cancer will inform the development and implementation of efficient and effective oral cancer prevention and management strategies. This systematic review and meta-analysis aimed to estimate the prevalence of oral cancer in Nigeria to guide relevant oral health interventions and policies.MethodsWe searched PubMed, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science for studies published from 1990 until August 15, 2023. We included cohort, cross-sectional, case-control, descriptive, and interventional studies that reported prevalence data for oral cancer in Nigeria. The primary outcome was the pooled prevalence of oral cancer. Meta-analysis was performed using the random effect model. The Higgins inconsistency index -I2 index was used to evaluate heterogeneity. The quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist.ResultsIn total, 3025 articles were screened, and data from 7 studies with a total sample size of 9188 (1702 oral cancer cases) were included in the meta-analysis. Participants age ranged from 0 to 100 years. Oral cancer prevalence varied across the studies, ranging from 7.5% to 41%. The pooled prevalence of oral cancer in Nigeria was 20% (95% confidence interval, CI:0.11–0.28, I2 = 99%, P < 0.0001). An estimate of the total variation between studies revealed substantial heterogeneity (I2 = 99%). The prevalence rate differed between gender populations, with more predilection to males (11%) than females (7%).ConclusionsThe current analysis indicates an overall pooled oral cancer prevalence of 20% in Nigeria. The high burden of oral cancer in Nigeria highlights a need for public health interventions and policies to promote the prevention and early detection of oral cancer. The analysis also shows a higher prevalence of oral cancer among men. Population-based studies are necessary to better understand individual differences in oral cancer.

To identify and quantify the direct and indirect economic cost of treatment for visceral leishmaniasis (VL) with conventional Amphotericin B deoxycholate, currently the first-line treatment in Muzaffarpur. Costs of patient management for VL were estimated from a societal and household perspective by means of a questionnaire designed for this study, interviews and financial reports. The total cost of care per episode of VL from the societal perspective was estimated at US$355, equivalent to 58% of annual household income. The largest cost category was medical costs (55%), followed by indirect costs (36%) and non-medical costs (9%). The cost from the household perspective was equivalent to US$217. The largest cost category was indirect costs (59%), followed by medical costs (27%) and non-medical costs (15%). Loss of income because of illness and hospitalization and expenses for drugs were the largest cost components. The economic costs related to VL are substantial, both to society and the patient. Public health authorities in Bihar should focus on policies that detect VL in the early stage and implement interventions that minimize the burden to households affected by VL.