Transcript Dengue Burden and Cost-of-Illness A Multi-country Study

Multi-country Study of Costs of
Dengue among Ambulatory and
Hospitalized Patients
Presentation at:
American Society of Tropical Medicine and Health 56th
Annual Meeting, Philadelphia, PA, Nov. 5, 2007
Abstract in:
Am J Trop Med Hyg 77(5, Suppl): 9.
Multi-country Study of Costs of Dengue
among Ambulatory and Hospitalized
Patients
Jose A. Suaya, Donald S. Shepard, Blas Armien,
Mariana Caram, Leticia Castillo, Ngan Chantha,
Fàtima Garrido, Sukhontha Kongsin, Lucy Lum,
Romeo Montoya, Binod K. Sah, João B. Siqueira,
Rana Sughayyar, Karen Tyo
Brandeis University and other institutions
ASTMH Annual Meeting
Philadelphia, PA
Nov. 5, 2007
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Objectives
 Understand the disease burden and
economic burden per dengue episode
 Examine these burdens across the
diversity of countries and settings in
which dengue is treated.
 Strengthen research capacity and focus
on dengue in dengue-endemic countries
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Participating countries
 The Americas
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Brazil
El Salvador
Guatemala
Panama
Venezuela
 Asia
 Cambodia
 Malaysia
 Thailand
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Joint core protocol included
 Common patient survey instrument
 Common medical record extraction form
 Common spreadsheet for hospital cost
analysis
 Common data base
 Common data cleaning procedures
 Common data analysis procedures
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Core features for study cohort
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Clinical dengue cases
Inpatients in public hospital
Both sexes
Children aged 0-14
Urban populations
Interview at end of the illness period
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Consent, contact and follow-up
form
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Patient survey -- information on:
 patient’s health
 health seeking behaviors
 types and amounts of ambulatory and
inpatient medical services obtained
 types and amounts of non-medical services
consumed
 amounts of out-of-pocket payments by type
of service, days of school and work
absenteeism
 income lost by the patient or household
members
 days of illness by patient
 hours of patient care by household members
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Investigators in Americas
Participants, left to right: Front: Clare Hurley (Brandeis), Leticia Castillo (Guatemala), Evelia Quiroz (Panama),
Donald Shepard (Brandeis), Fatima Garrido (Venezuela), Celina Turchi Martelli (Brazil); Middle: Romeo Montoya
(El Salvador), Rafael Chacon (El Salvador), Jose Suaya (Brandeis), Joao Siquiera (Brazil); Back: Blas Armien
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(Panama), Carlos Ovando (Guatemala), Mariana Caram (Brandeis).
Investigators in Asia
Back row, left to right: Padejsak Chobtum, MSc. cand. (Thailand), Nootchawon Boonruang, MSc. cand. (Thailand), Kanoksak
Wongpeng, MSc. cand. (Thailand), Tan Lian Huat, M.D. (Malaysia), Sukhum Jiamton, M.D., Ph.D. (Thailand), Sukhontha
Kongsin, Ph.D. (Thailand), Jose Suaya, M.D., Ph.D. (Heller), Sirenda Vong, M.D. (Cambodia), Chantha Ngan, M.D.
(Cambodia), Rekol Huy, M.D. (Cambodia), Lucy Lum Chai See, M.D. (Malaysia), Siriyaporn Khantasorn, MSc. cand. (Thailand),
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Petcherut Sirisuvan, MSc. cand. (Thailand).
Unit of analysis: clinical dengue case
 Patient seeking care for acute febrile
illness
 Clinical diagnosis of dengue
 Treated at health facility
 With or without laboratory confirmation
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Economic impact components
 Direct medical cost
 Direct non-medical cost
 Indirect cost
 Patients and households
 Employers
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Participant characteristics by country
Country
Brazil
El Salvador
Guatemala
Panama
Venezuela
Cambodia
Malaysia
Thailand
Total
Number of
participants
550
189
85
136
200
%
Hospitalized
25%
47%
25%
4%
35%
% Age 0-14
14%
100%
41%
12%
63%
% of Households with
vocational or college
education
28%
27%
18%
48%
22%
127
235
173
1695
100%
55%
100%
45%
98%
30%
99%
48%
5%
34%
20%
27%
From Table H1a
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Household days affected per hospitalized dengue episode
25
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Other Household members
Patient
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20
20
19
19
18
17
16
16
Days
15
10
5
0
Entire
cohort
BRA
ESAL
GUA
PAN
VEN
CAM
MAL
THA
Country
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Self-reported economic impact on
household in hospitalized patients
Cohort size
Number of patients
Row percentage
Amount of impact*
None
Some
Quite a lot
Very substantial
Total
Americas
Entire
cohort
BRA
756
100%
140
19%
13%
55%
24%
8%
100%
24%
65%
11%
0%
100%
ELS GUA
Asia
PAN
VEN CAM
89
21
6
70
127
12%
3%
1%
9% 17%
Column percentages
66%
0% 17%
0%
0%
24% 62% 17% 77% 22%
10% 38% 67% 23% 71%
0%
0%
0%
0%
7%
100% 100% 100% 100% 100%
MAL THA
130
17%
173
23%
1%
1%
96% 51%
3% 19%
0% 29%
100% 100%
* Based on a four-point scale question
From Table H9
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Costs in hospitalized cohort
Cost per case in hospitalized cohort
$2,500
Total cos t
Indirect cos t
Direct cos t
$1,988
$2,000
249
$1,704
Cost per case (I$)
$1,622
$1,758
137
$1,500
$1,394
515
336
840
$960
$1,000
170
$815
$752
$756
1,739
1,621
204
102
1,189
363
1,058
$500
782
790
651
610
393
$0
BRA
ESAL
GUA
PAN
VEN
CAM
MAL
THA
ALL
Country
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Costs in ambulatory cohort
Cost per case in ambulatory cohort
$1,000
Total cost
$900
Indirect cost
Direct cost
$800
$699
$666
Cost per case (I$)
$700
$600
$531
$514
219
$500
$400
579
399
372
$300
$184
$200
$218
447
$158
128
133
$100
110
132
121
$0
BRA
51
48
ESAL
GUA
PAN
142
90
VEN
CAM
MAL
THA
ALL
Country
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Cost per dengue case in terms of
days of GDP per capita
 Hospitalized cases
 Mean: 76 days
 Range (days): 46 in Venezuela to 111 in
Cambodia
 Ambulatory cases
 Mean: 24 days
 Range (days): 12 in Venezuela to 31 in
Brazil
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The cost per case of dengue is generally
higher than previously estimated
 These studies generally find a higher cost
of illness per case than previous dengue
research due to more comprehensive
assessment
 The average for our ambulatory cohort
(24 days of GDP per capita) is at the mid
point of other studies
 The average for our hospitalized cohort
(80 days of GDP per capita) is higher
than all of the other studies
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Previous studies of dengue cost
compared to present study
 Previous studies were single country
 Generally topical in scope
 E.g. Several focused on out-of-pocket
expenditure, but excluded government
subsidy
 Used multiple assumptions in the
absence of actual data.
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The cost per case of dengue is
generally higher than that for other
infectious diseases
 The average cost of illness of the
ambulatory dengue cases (equivalent to 24
days of GDP) ranks moderately high (at the
71st percentile) against 14 comparators
 The average cost of the hospitalized dengue
cases (equivalent to 76 days of GDP) is very
high (at the 93rd percentile) against 14
comparators
For references see Scientific Report
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Conclusions
 On a per case basis, the cost of a dengue
episode is substantial
 Both direct and indirect components are
important
 Costs fall on all sectors:
 Government
 Employers
 Households
 Policymakers are very interested in costs of
dengue
For references see Scientific Report
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Acknowledgments
 Other collaborating researchers
 PDVI staff and advisors: Mark
Beatty, Diana Edgil, Scott
Halstead, Susie Kliks, Joel
Kuritsky, Bill Letson, Richard
Mahoney, Harold Margolis
 Sponsor: Pediatric Dengue
Vaccine Initiative
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THANK YOU!
 [email protected]
 [email protected]
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