1
|
Weerasinghe NP, Bodinayake CK, Wijayaratne WMDGB, Devasiri IV, Dahanayake NJ, Kurukulasooriya MRP, Premamali M, Sheng T, Nicholson BP, Ubeysekera HA, de Silva AD, Østbye T, Woods CW, Tillekeratne LG, Nagahawatte ADS. Direct and indirect costs for hospitalized patients with dengue in Southern Sri Lanka. BMC Health Serv Res 2022; 22:657. [PMID: 35578247 PMCID: PMC9112532 DOI: 10.1186/s12913-022-08048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Southern Province of Sri Lanka is endemic with dengue, with frequent outbreaks and occurrence of severe disease. However, the economic burden of dengue is poorly quantified. Therefore, we conducted a cost analysis to assess the direct and indirect costs associated with hospitalized patients with dengue to households and to the public healthcare system. Methods From June 2017–December 2018, we prospectively enrolled children and adults with acute dengue hospitalized at the largest, public tertiary-care (1800 bed) hospital in the Southern Province, Sri Lanka. We administered a structured questionnaire to obtain information regarding direct costs spent by households on medical visits, medications, laboratory testing, and travel for seeking care for the illness. Indirect costs lost by households were estimated by identifying the days of work lost by patients and caregivers and school days lost by children. Direct hospital costs were estimated using gross costing approach and adjusted by multiplying by annual inflation rates in Sri Lankan rupees and converted to US dollars. Results A total of 1064 patients with laboratory-confirmed dengue were enrolled. The mean age (SD) was 35.9 years (15.6) with male predominance (66.2%). The mean durations of hospitalization for adults and paediatric patients were 3.86 (SD = 1.51) and 4 (SD = 1.32) days, respectively. The per-capita direct cost borne by the healthcare system was 233.76 USD, and was approximately 14 times greater than the per-capita direct cost borne by households (16.29 USD, SD = 14.02). The per-capita average number of loss of working days was 21.51 (SD = 41.71), with mean per-capita loss of income due to loss of work being 303.99 USD (SD = 569.77), accounting for over 70% of average monthly income. On average, 10.88 days (SD = 10.97) of school days were missed due to the dengue episode. School misses were expected to reduce future annual income of affected children by 0.44%. Conclusions Dengue requiring hospitalization had a substantial economic burden on the public healthcare system in Sri Lanka and the affected households. These findings emphasize the importance of strengthening dengue control activities and improved use of hospital-based resources for care to reduce the economic impact of dengue in Sri Lanka.
Collapse
Affiliation(s)
- N P Weerasinghe
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka. .,Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
| | - C K Bodinayake
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - W M D G B Wijayaratne
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - I V Devasiri
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Pediatrics, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - N J Dahanayake
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - M R P Kurukulasooriya
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - M Premamali
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - T Sheng
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Medicine, Duke University, Durham, NC, USA
| | - B P Nicholson
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Institute for Medical Research, Durham, NC, USA
| | | | - A D de Silva
- Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - T Østbye
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - C W Woods
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - L G Tillekeratne
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Medicine, Duke University, Durham, NC, USA
| | - A De S Nagahawatte
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA
| |
Collapse
|