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Dengue incidence is increasing globally — but at what cost, and to whom?
In a recent, vaccine manufacturer–supported study, researchers used surveillance data, patient interviews, medical records, and financial data from patients, health facilities, and insurance companies to estimate the annual average aggregate costs of treated dengue cases in Puerto Rico from 2002 through 2010. Cost per case — used to project aggregate cost — was determined through detailed assessment of 100 patients with laboratory-confirmed dengue, of whom 67 were hospitalized and 44 were aged <15 years.
During the study period, >60,000 suspected dengue cases were reported; >22,000 of these cases were confirmed. The average annual aggregate cost of treated cases was $38.7 million ($10.40 per capita); adults accounted for 70% of these costs, and hospitalized patients for 63%. Households incurred 48% of such cost, the government 24%, insurance 22%, and employers 7%. When the cost of surveillance and control programs were added to the cost of dengue illness, the aggregate cost rose to $46.4 million ($12.47 per capita). Work absenteeism per episode exceeded that shown for influenza in the U.S. and other industrialized countries.
Halasa YA et al. Economic cost of dengue in Puerto Rico. Am J Trop Med Hyg 2012 May; 86:745.
Gubler DJ. The economic burden of dengue. Am J Trop Med Hyg 2012 May; 86:743.
Comment
As noted by the authors and an editorialist, the economic burden of dengue has been poorly defined and generally underestimated. In Puerto Rico, households funded almost half the cost of illness. The cost of dengue illness there was roughly five times the cost of surveillance and vector-control programs, leading the authors to suggest that increases in the latter would pay off economically. This analysis is useful for planners considering investments in interventions, including vaccines, but because of regional differences in dengue epidemiology, costs will vary by geographic region.