Things to Remember
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Medicine prices have gone crazy: Albendazole, a basic deworming medication that used to cost $2, now costs around $180-200 for a simple 3-day treatment. This happened because drug companies stopped making it when they decided parasite infections were only a problem in other countries.
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High costs change how doctors treat you: When medications are this expensive, doctors sometimes have to ask uncomfortable questions like "Is this infection bad enough to justify the cost?" rather than simply prescribing what works best. You might be offered less effective alternatives just because they're cheaper.
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Common infections are going untreated: Pinworms (those tiny white worms that cause intense nighttime itching, especially in kids) are very common but now cost $160-200 to treat properly. Many families skip treatment because of the cost, leading to ongoing misery and the infection spreading to others.
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Doctors may avoid testing in the first place: If your doctor knows the treatment is unaffordable, they might not even test for parasites, creating a cycle where infections go undiagnosed and untreated - meanwhile you're left dealing with unexplained fatigue, digestive issues, and other symptoms.
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Untreated infections cost more in the long run: While $180 for pills seems expensive now, leaving parasite infections untreated leads to repeated doctor visits, more tests, lost work days, and sometimes serious complications down the road - especially if you ever need medications that weaken your immune system.
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There are some workarounds, but they're not ideal: For pinworms specifically, strict hygiene (short nails, frequent handwashing, daily changes of bedding washed in hot water) sometimes works. Some older medications like pyrantel pamoate are available over-the-counter and cheaper, though they don't work for all types of parasites.
This article explains why albendazole - a common parasite medication - has become unexpectedly expensive in the United States and what options patients have when facing high treatment costs.
The pharmacist looked at me like I'd made a mistake. "That's $180 for a three-day course," she said, pointing at the screen. "Are you sure that's the right medication?"
Common Parasitic Infections: Cost vs. Treatment Comparison
| Infection | Typical Symptoms | First-Line Treatment | Approximate Cost (US/Australia) | Treatment Duration |
|---|---|---|---|---|
| Pinworm (Enterobius) | Perianal itching (worse at night), visible white worms, sleep disturbance, irritability in children | Albendazole 400mg OR Mebendazole 100mg | $160-200 (two doses total) | Single dose, repeated after 2 weeks |
| Threadworm (Strongyloides) | Abdominal pain, diarrhea, urticaria, larva currens rash, eosinophilia | Ivermectin 200mcg/kg OR Albendazole 400mg twice daily | $50-150 (varies by drug/source) | 1-2 days (ivermectin) or 3-7 days (albendazole) |
| Hookworm (Ancylostoma/Necator) | Iron-deficiency anemia, abdominal pain, diarrhea, fatigue, ground itch at entry site | Albendazole 400mg once daily | $180 for 3-day course | 3 days |
| Roundworm (Ascaris) | Often asymptomatic, abdominal discomfort, intestinal obstruction (heavy infections), visible worms in stool | Albendazole 400mg single dose OR Mebendazole 100mg twice daily | $80-100 (single dose) or $160-200 (3-day course) | 1 day (albendazole) or 3 days (mebendazole) |
| Whipworm (Trichuris) | Abdominal pain, bloody diarrhea (heavy infections), rectal prolapse (severe cases), anemia | Albendazole 400mg once daily OR Mebendazole 100mg twice daily | $180-270 (3-day course) | 3 days |
| Giardia | Watery diarrhea, bloating, foul-smelling greasy stools, weight loss, malabsorption | Tinidazole 2g single dose OR Metronidazole 400mg three times daily | $15-40 (generic metronidazole) | 1 day (tinidazole) or 5-7 days (metronidazole) |
Note: Costs reflect generic medication prices in countries experiencing benzimidazole shortages (2020-2024). Prices vary significantly by pharmacy, insurance coverage, and geographic location. WHO Essential Medicines List pricing in low-income countries: albendazole usually $0.02-0.50 per tablet.
I was sure. Albendazole, 400mg tablets, twice daily for three days. The same drug that cost two dollars when I was in medical school. The same drug that's on the WHO Essential Medicines List - meaning it's supposed to be accessible and affordable worldwide. But somewhere between then and now, something broke in the pharmaceutical supply chain, and now a generic antiparasitic that should cost pocket change routinely exceeds the price of dinner for two at a nice restaurant.
This isn't just about money. Though it is about money. It's about what happens when basic medical tools become inaccessible, and how that shifts the entire risk-benefit calculation of diagnosis and treatment.
The Economics of Neglect
Albendazole and mebendazole belong to a class called benzimidazoles - compounds that work by disrupting the microtubule formation in parasites, essentially preventing them from maintaining their cellular structure and metabolism. They've been around since the 1970s. They're generic. They're off-patent. They should be cheap.
But here's what happened: as Western nations convinced themselves that parasitic infections were problems of "elsewhere," demand dropped. Pharmaceutical companies consolidated. Manufacturing lines shut down or moved offshore. Generic producers stopped making these drugs because the profit margins weren't worth it. And suddenly, in countries like Australia and the United States, albendazole became hard to find. When supply contracts and demand persists - even at low levels - prices rise.
Now we're in this absurd situation where a doctor can suspect a parasitic infection, order appropriate testing, get a positive result, and then have to explain to a patient why the treatment costs more than the imaging that found it. I've watched people decline treatment because they couldn't justify the expense for something that wasn't immediately life-threatening. And I understood. Two hundred dollars for three pills is a lot when you're weighing it against groceries or petrol or keeping the electricity on.
The cruel irony is that untreated parasitic infections cost more in the long run - in persistent symptoms, repeated medical visits, unnecessary investigations, lost productivity. But that cost is distributed and invisible. The $180 is right there, concrete and immediate.
What Happens When We Can't Treat
When treatment becomes prohibitively expensive, clinical decision-making changes. You start asking different questions. Is this infection severe enough to justify the cost? Could we try empiric treatment with something else, something cheaper, even if it's less effective? Should we wait and see if symptoms resolve on their own?
These aren't the questions you want to be asking. But they're the questions economics forces on you.
Take pinworm (Enterobius vermicularis - a small threadlike worm that causes intense perianal itching, especially at night). It's the most common helminth infection in developed countries, particularly in children. The classic presentation is a kid who can't sleep because of the itching, and the parent finds small white worms in the stool or on the perianal skin. The diagnosis is usually clinical, sometimes confirmed with a "tape test" - pressing clear tape against the perianal region in the morning to catch eggs, then examining it under a microscope.
The recommended treatment is a single dose of mebendazole or albendazole, repeated two weeks later. That's it. Two tablets total. But if those tablets cost $80-100 each, suddenly you're prescribing $160-200 worth of medication for a condition that, while miserable, isn't life-threatening. Some families can't justify that. So they try over-the-counter options, herbal remedies, hoping the infection resolves on its own. Sometimes it does. Often it doesn't. And the cycle continues - the child stays symptomatic, the family stays frustrated, and the worms keep reproducing.
I've started keeping a mental list of workarounds. For pinworm, strict hygiene measures sometimes work - short nails, frequent handwashing, daily change of underwear and bedding, all washed in hot water. It's not as reliable as medication, but it costs nothing. For some intestinal worms, older medications like pyrantel pamoate (a neuromuscular blocker that paralyzes worms so they pass in stool) are available over-the-counter and cheaper, though they're less broad-spectrum and don't cover protozoa.
But these are compromises born of economic constraint, not optimal medicine.
The Compounding Problem
The high cost of treatment also affects diagnostic behaviour. If you know the medication is expensive and potentially inaccessible, you're less likely to test for parasites in the first place. Why put someone through the hassle of collecting stool samples over multiple days, the indignity of bringing faecal matter to a lab, the wait for results - when even if you find something, treatment might not be feasible?
This creates a vicious cycle. Fewer tests means fewer diagnosed infections. Fewer diagnosed infections reinforces the perception that parasites are rare. That perception further reduces demand for medications, which keeps prices high or drives more manufacturers out of the market.
Meanwhile, people walk around with chronic, low-grade infections that sap their energy, disrupt their digestion, and occasionally cause more serious complications. Strongyloides stercoralis, for instance, can persist for decades in an asymptomatic carrier state. But if that person becomes immunocompromised - from chemotherapy, high-dose corticosteroids, HIV - the parasite can disseminate throughout the body in a condition called hyperinfection syndrome. It's devastating, with mortality rates exceeding 50% even with treatment.
The standard preventive approach is to screen and treat high-risk patients before starting immunosuppression. But if treatment costs $180 for a five-day course, and the drug is on backorder, that prevention becomes harder to execute.
Ivermectin: The Complicated Alternative
Then there's ivermectin. It's another antiparasitic, originally developed for veterinary use, later repurposed for humans. It's extraordinarily effective against certain parasites, particularly Strongyloides, onchocerciasis (river blindness - a parasitic disease caused by a filarial worm transmitted by blackflies), and some ectoparasites like scabies and lice.
For a while, ivermectin was more accessible and cheaper than albendazole in some regions. It became the go-to for Strongyloides treatment and occasionally for other helminth infections off-label. Then COVID-19 happened, and ivermectin got caught up in a public health controversy that I'm not interested in relitigating here. But one consequence was that pharmacies and regulators became more cautious about dispensing it. Supply chains got disrupted. Misinformation on both sides created confusion.
Now, when you write a prescription for ivermectin for a legitimate parasitic indication, you sometimes get pushback. Pharmacists ask extra questions. Patients worry it's "that controversial COVID drug." The whole thing has become needlessly complicated, layered with cultural and political baggage that has nothing to do with whether someone has intestinal worms.
The medicine itself hasn't changed. It still works. But the context around it has shifted in ways that make prescribing it more fraught.
What We're Left With
So here's where we are: parasitic infections are more common in developed nations than most people realize. Diagnostic testing is imperfect and often requires persistence. The most effective treatments are either expensive, hard to access, or caught up in unrelated controversies. And all of this exists against a backdrop of medical systems that don't prioritize parasitology because the prevailing assumption is that these infections are rare here.
They're not rare. They're underdiagnosed, undertreated, and increasingly difficult to address even when we do identify them.
I don't have a clean solution to this. The pharmaceutical economics are complex - driven by consolidation, supply chain fragility, and the reality that there's limited profit in drugs that are taken for a few days once or twice in a lifetime. Public health campaigns could increase awareness, but that requires funding and political will. Regulatory changes could make older, off-patent medications more accessible, but that requires navigating bureaucracy.
What I do know is that we've created a system where people suffer needlessly from treatable conditions because the tools to treat them have become inaccessible. And that's not just a medical failure. It's an ethical one.
Someone asked me recently if I think parasitic infections are on the rise. I said I don't know. Maybe they are. Maybe we're just noticing them more now that some people are paying attention. But I think the more important question is: even if we notice them, can we actually do anything about it?
Right now, the answer is: sometimes. For some people. If they can afford it. If the drug is in stock. If the prescription doesn't get flagged or questioned.
That's not good enough. But it's where we are.
