Economic cost of Hansen's disease: an overview of social security expenditures

Brazil is the second highest worldwide regarding new cases of Hansen's disease (HD), with over 20,000 diagnoses annually. Late detection often results in severe disabilities that impair daily functioning, reduce work capacity, and increase reliance on state financial assistance, which contribute to public expenditure. This study quantified the economic impact of Hansen's disease by analyzing social security benefits in relation to the disease's epidemiological profile from the late 20th century to the first two decades of the 21st century.

This retrospective, longitudinal, descriptive study applied a cost-of-illness (COI) approach from a societal perspective. Indirect costs attributable to Hansen's disease were estimated using social security transfer payments as proxies for productivity loss. Administrative data from the National Institute of Social Security were obtained for all benefits granted between 2000 and 2019. These records included temporary, long-term, and lifetime benefits, which were categorized by type, duration, sex, geographic location, and total financial disbursement. The economic evaluation considered both annual and accumulated payments over the study period. To contextualize the burden of disease, benefit data were analyzed alongside epidemiological indicators from the Ministry of Health's Notifiable Diseases Information System, allowing the examination of the relationship between Hansen's disease trends and variations in benefit concessions.

Systematic variations were identified in the number of benefits granted, with a marked increase until 2005, followed by an abrupt drop and a subsequent gradual decline. These fluctuations were influenced by exogenous monetary and political factors and changes in benefit requests. Long-term benefits followed the same pattern, stabilizing at approximately 1,000 grants per year. Temporary benefits showed recurrent oscillations and later declined from 4,283 in 2000 to 3,525 in 2019, remaining substantially more frequent than lifetime benefits. Data segmentation showed the following: (I) age at entry into the social security system peaked at 45 to 55 years for both sexes; (II) men received 2.7 times more benefits; (III) benefit duration was similar for men and women, with 52.0% ending within 18 months and 85.0% within 120 months; (IV) the Southeast region accounted for 21.8% of benefits and 24.8% of new cases; and (V) total payments increased over 60-fold, reaching US$ 91 million in 2019.

Social security expenditures for beneficiaries with Hansen's disease totaled US$ 924.6 million, representing a substantial economic burden relative to the disease's epidemiological characteristics in Brazil. Although incidence has declined and benefit concessions have gradually decreased, partly due to improvements in administrative processes and Hansen's disease control, the financial impact remains significant. Given that Hansen's disease is curable, and treatment is freely available in the public health system, current resource allocation prioritizes compensation for productivity loss over early diagnosis and prevention. The identified disparities, including gender differences and concentration of benefits in wealthier regions, warrant further investigation to inform mitigation strategies.