Objective: The state of leprosy in Nigeria and the realities of post elimination era require evidence- based cost-effective approach to early case detection for more effective control and elimination of leprosy. This study evaluated the operational cost-effectiveness of a community delivered Legacy Innovative Project (LIP) implemented to enhance leprosy case detection in northern Nigeria.

Method: The study was an explorative cross-sectional study, undertaken in a practice setting, targeting endemic communities in three states in northern Nigeria. Primary and secondary data were collected from the project, routine records and annual reports. Costs and effects were measured from both providers’ and patients’ perspectives, and outcome expressed as cost per case detected. Incremental estimates were used to obtain the cost-effectiveness result, as incremental cost-effectiveness ratio (ICER). All costs were converted to the US Dollar (US$) at 2018 exchange rate (N350 = US$1.00). Univariate sensitivity analysis was performed to evaluate uncertainties around the ICER.

Result. The community Project (LIP) overall detected a total of 347 newly confirmed leprosy cases at a total annual cost of US$49,337.19, averaging US$142.18 per new case detected. Key cost drivers were routine meeting which accounted for 28% of total expenditure, Social Mobilization and Training/Workshop expenses at 17% respectively. Findings were similar at individual state levels. Overall, the Legacy Project dominated routine practice with ICER of US$-17.73 per additional case detected. The study demonstrated that greater gains/more cases are obtained for every dollar spent with the community strategy compared to routine practice, and with the ICER at a negative value indicate that greater resource savings are associated with the Legacy Project.

Conclusion: The Legacy Project at all levels demonstrated a more efficient and cost-saving approach to leprosy case detection. Findings present important information to policy and programmes for enhanced control and elimination of leprosy in related settings.