Economic burden of chronic pulmonary aspergillosis in Uganda: a cost-of-illness analysis

Chronic pulmonary aspergillosis (CPA) is a complication of tuberculosis that is under-recorgnizedin resource-limited settings. We quantified the economic burden of CPA in Uganda from societal, healthcare system, and household perspectives. We used a prevalence-based cost-of-illness approach with an estimated 26,765 annual CPA cases, stratified by clinical subtype. Direct medical costs were obtained from local health facilities and Joint Medical Stores pricing. Undiagnosed cases were modeled through a tuberculosis misdiagnosis pathway with 20% annual mortality. Productivity losses were estimated using disability-adjusted life years (DALYs), valued at Uganda's gross domestic product (GDP) per capita ($1072.70). We used return-on-investment (ROI) analysis to compare full (100%) diagnostic coverage with the current estimated 10%. Structural scenario analyses varied undiagnosed mortality (15-30%), healthcare costs, and baseline coverage. At 100% coverage, total annual direct medical costs were $20,136,000 and productivity losses were $63,642,000, giving a total economic burden of $83,778,000 (0.16% of GDP), with 1,833 deaths and 59,329 DALYs. At 10% coverage, the burden was $162,749,000 (0.30% of GDP). Expanding coverage from 10% to 100% generated net savings of $78,971,000 (ROI of 4.73:1), robust across all scenarios (range 2.50 - 8.99). Mean out-of-pocket expenditure was $256.47 per patient, representing a catastrophic burden for low-income households. Total burden was most sensitive to annual CPA cases, while mortality among undiagnosed patients most influenced net savings. CPA imposes a substantial economic burden in Uganda. Underdiagnosis leads to avoidable mortality, productivity losses, and catastrophic costs. Integrating CPA screening into tuberculosis services and expanding diagnostic capacity are justified strategies aligned with Uganda's universal health coverage goals.