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Hung TM, Shepard DS, Bettis AA, Nguyen HA, McBride A, Clapham HE, Turner HC. Productivity costs from a dengue episode in Asia: a systematic literature review. BMC Infect Dis 2020; 20:393. [PMID: 32493234 PMCID: PMC7268537 DOI: 10.1186/s12879-020-05109-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/20/2020] [Indexed: 01/22/2023] Open
Abstract
Background Dengue is a mosquito-borne viral infection which has been estimated to cause a global economic burden of US$8.9 billion per year. 40% of this estimate was due to what are known as productivity costs (the costs associated with productivity loss from both paid and unpaid work that results from illness, treatment or premature death). Although productivity costs account for a significant proportion of the estimated economic burden of dengue, the methods used to calculate them are often very variable within health economic studies. The aim of this review was to systematically examine the current estimates of the productivity costs associated with dengue episodes in Asia and to increase awareness surrounding how productivity costs are estimated. Method We searched PubMed and Web of Knowledge without date and language restrictions using terms related to dengue and cost and economics burden. The titles and abstracts of publications related to Asia were screened to identify relevant studies. The reported productivity losses and costs of non-fatal and fatal dengue episodes were then described and compared. Costs were adjusted for inflation to 2017 prices. Results We reviewed 33 relevant articles, of which 20 studies reported the productivity losses, and 31 studies reported productivity costs. The productivity costs varied between US$6.7–1445.9 and US$3.8–1332 for hospitalized and outpatient non-fatal episodes, respectively. The productivity cost associated with fatal dengue episodes varied between US$12,035-1,453,237. A large degree of this variation was due to the range of different countries being investigated and their corresponding economic status. However, estimates for a given country still showed notable variation. Conclusion We found that the estimated productivity costs associated with dengue episodes in Asia are notable. However, owing to the significant variation in methodology and approaches applied, the reported productivity costs of dengue episodes were often not directly comparable across studies. More consistent and transparent methodology regarding the estimation of productivity costs would help the estimates of the economic burden of dengue be more accurate and comparable across studies.
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Affiliation(s)
- Trinh Manh Hung
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.
| | - Donald S Shepard
- Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, USA
| | - Alison A Bettis
- London Centre for Neglected Tropical Disease Research, London, UK.,Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Marys Campus, Imperial College London, Norfolk Place, London, UK
| | - Huyen Anh Nguyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Angela McBride
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer, Brighton, England
| | - Hannah E Clapham
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Hugo C Turner
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London, UK
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Gong L, Wang J, Zhang Y, Zhang L, Lyu Y, Ma W, Gao W, Chen W, Zhou Y, Wu J, Su B. Socioeconomic burden of severe fever with thrombocytopenia syndrome in endemic areas of Anhui Province, eastern China. Zoonoses Public Health 2019; 66:879-885. [PMID: 31334609 DOI: 10.1111/zph.12634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/18/2019] [Accepted: 06/29/2019] [Indexed: 01/30/2023]
Abstract
Understanding the socioeconomic burden of severe fever with thrombocytopenia syndrome (SFTS) is important for making decisions on health resources allocation. This study aimed to assess the economic burden of patients with this syndrome in endemic areas of the Anhui Province in 2018. A total of 114 patients were recruited, and the median age was 63.5 years, 62 (54.4%) were female, 97 (85.1%) were farmers, 108 (94.7%) were survival patients, and 71 (62.3%) had a family monthly income less than $453.3. The median times of hospital visits and hospitalizations of patients were three times, and the median lost work days of these patients, caregivers and visitors were 14.5 days, 14.5 days and 7.5 days, respectively. The median direct costs of the patient were $3,761.6, and the median indirect costs were $508.3. Taking direct and indirect costs into consideration, the median total economic costs of patients were $4,323.9, and the total annual cost of 2018 was $1,396,913.6. Although 113 (99.1%) patients had medical insurance, only 25.8% of costs were covered by reimbursement, and the total cost paid for by the patients and their families was $1,041,073.6 in 2018. Our findings revealed that the patients and their families had a significant economic burden, and preventive measures should be strengthened in endemic areas. The findings also provided baseline data for assessing the cost-effectiveness of the vaccines or anti-viral drugs in the near future in China.
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Affiliation(s)
- Lei Gong
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Jinsheng Wang
- Anqing Municipal Center for Disease Control and Prevention, Anqing, China
| | - Yong Zhang
- Chuzhou Municipal Center for Disease Control and Prevention, Chuzhou, China
| | - Lei Zhang
- Hefei Municipal Center for Disease Control and Prevention, Hefei, China
| | - Yong Lyu
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Wanwan Ma
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Weilin Gao
- Anqing Municipal Center for Disease Control and Prevention, Anqing, China
| | - Weiguo Chen
- Chuzhou Municipal Center for Disease Control and Prevention, Chuzhou, China
| | - Yu Zhou
- Lu'an Municipal Center for Disease Control and Prevention, Lu'an, China
| | - Jiabing Wu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Bin Su
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
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Machado AAV, Negrão FJ, Croda J, de Medeiros ES, Pires MADS. Safety and costs of blood transfusion practices in dengue cases in Brazil. PLoS One 2019; 14:e0219287. [PMID: 31283788 PMCID: PMC6613682 DOI: 10.1371/journal.pone.0219287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/20/2019] [Indexed: 11/19/2022] Open
Abstract
Background Dengue is a public health problem, and noncompliance with World Health Organization (WHO) recommendations for blood transfusion components is frequently reported. Moreover, economic impact studies of the WHO recommendations on the use of blood transfusion are scarce. Methods We compared the cost and hospitalization time in a prospective observational study, by following hospitalised patients and analysing their medical records from 2010 and March 2016 to December 2017. We divided the patients into two groups: transfused (with or without WHO criteria for transfusion) and not transfused (with or without WHO criteria for transfusion). Generalised linear modelling was performed to identify the variable that could increase the costs and hospital stay. Results Among 323 patients, 52 were transfused, of whom 52% without criteria (n = 27), and 271 were not transfused, of which 4.4% (n = 12) with criteria. Hospitalisation costs were 41% higher in the transfused group without criteria than in those with criteria (median US$ 674.3 vs US$ 478 p = 0.293). Patients who were not transfused but met the WHO criteria for transfusion (n = 12) had longer mean hospitalisation time than did those who were not transfused (3.8±3.4 days versus 3.6±3.1 days; p = 0.022). The GLM analysis using hospital stay and costs as the dependent variable explained approximately 33.4% (R2 = 0.334) of the hospitalisation time and 79.3% (R2 = 0.793) of costs. Receiving a transfusion increased the hospitalization time by 1.29 days (p = 0.0007; IRR = 1.29), and the costs were 5.1 times higher than those without receiving blood components (IRR = 5.1; p< 0.001; median US$ 504.4 vs US$ 170.7). In contrast, patients who were transfused according to WHO criteria had a reduction in costs of approximately 96% (IRR = 0.044; p<0.001; β = -3.12) compared to that for those who were not transfused according to WHO criteria (without criteria). Conclusion Transfusion without following WHO recommendations increased the time and cost of hospitalisation.
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Affiliation(s)
| | - Fábio Juliano Negrão
- Health Sciences College, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
- Universitary Hospital of Federal University of Grande Dourados, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
- * E-mail: (FJN); (AAVM)
| | - Júlio Croda
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Oswaldo Cruz Foundation, Campo Grande, Mato Grosso do Sul, Brazil
| | - Elias Silva de Medeiros
- Faculty of Exact Sciences and Technology, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Maria Aparecida dos Santos Pires
- Health Sciences College, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
- Universitary Hospital of Federal University of Grande Dourados, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
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Oliveira LNDS, Itria A, Lima EC. Cost of illness and program of dengue: A systematic review. PLoS One 2019; 14:e0211401. [PMID: 30785894 PMCID: PMC6382265 DOI: 10.1371/journal.pone.0211401] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/14/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies on dengue related to the cost of illness and cost of the program are factors to describe the economic burden of dengue, a neglected disease that has global importance in public health. These studies are often used by health managers in optimizing financial resources. A systematic review of studies estimating the cost of dengue was carried out, comparing the costs between the studies and examining the cost drivers regarding the methodological choices. METHODS This study was done according to the guidelines of the Centre for Reviews and Dissemination (CRD). Several databases were searched: Medline, Virtual Health Library and CRD. Two researchers, working independently, selected the studies and extracted the data. The quality of the methodology of the individual studies was achieved by a checklist of 29 items based on protocols proposed by the British Medical Journal and Consolidated Health Economic Evaluation Reporting Standards. A qualitative and quantitative narrative synthesis was performed. RESULTS A literature search yielded 665 publications. Of these, 22 studies are in accordance with previously established inclusion criteria. The cost estimates were compared amongst the studies, highlighting the study design, included population and comparators used (study methodology). The component costs included in the economic evaluation were based on direct and indirect costs, wherein twelve studies included both costs, twelve studies adopted the societal perspective and ten studies used the perspective of the public health service provider, or of a private budget holder. CONCLUSION This study showed that the cost of dengue in 18 countries generated approximately US$ 3.3 billion Purchasing Power Parity (PPP) in 2015. This confirms that the burden of dengue has a great economic impact on countries with common socioeconomic characteristics and similarities in health systems, particularly developing countries, indicating a need for further studies in these countries.
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Affiliation(s)
- Luana Nice da Silva Oliveira
- Faculty of Pharmacy, Center for Economics and Health Assessments, Institute of Health Technology Assessment, Federal University of Goiás, Goiás, Brazil
| | - Alexander Itria
- Institute of Tropical Pathology and Public Health, Department of Collective Health, Federal University of Goiás, Goiás, Brazil
- Center of Economics and Health Assessments, Institute of Health Technology Assessment, Federal University of Goiás, Goiás, Brazil
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Hung TM, Clapham HE, Bettis AA, Cuong HQ, Thwaites GE, Wills BA, Boni MF, Turner HC. The Estimates of the Health and Economic Burden of Dengue in Vietnam. Trends Parasitol 2018; 34:904-918. [PMID: 30100203 PMCID: PMC6192036 DOI: 10.1016/j.pt.2018.07.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022]
Abstract
Dengue has been estimated to cause a substantial health and economic burden in Vietnam. The most recent studies have estimated that it is responsible for 39884 disability-adjusted life years (DALYs) annually, representing an economic burden of US$94.87 million per year (in 2016 prices). However, there are alternative burden estimates that are notably lower. This variation is predominantly due to differences in how the number of symptomatic dengue cases is estimated. Understanding the methodology of these burden calculations is vital when interpreting health economic analyses of dengue. This review aims to provide an overview of the health and economic burden estimates of dengue in Vietnam. We also highlight important research gaps for future studies.
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Affiliation(s)
- Trinh Manh Hung
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Hannah E Clapham
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Alison A Bettis
- London Centre for Neglected Tropical Disease Research, London, UK; Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Marys Campus, Imperial College London, Norfolk Place, London W2 1 PG, UK
| | | | - Guy E Thwaites
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Bridget A Wills
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Maciej F Boni
- Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, PA, USA
| | - Hugo C Turner
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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A multi-country study of the economic burden of dengue fever: Vietnam, Thailand, and Colombia. PLoS Negl Trop Dis 2017; 11:e0006037. [PMID: 29084220 PMCID: PMC5679658 DOI: 10.1371/journal.pntd.0006037] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 11/09/2017] [Accepted: 10/14/2017] [Indexed: 01/01/2023] Open
Abstract
Background Dengue fever is a major public health concern in many parts of the tropics and subtropics. The first dengue vaccine has already been licensed in six countries. Given the growing interests in the effective use of the vaccine, it is critical to understand the economic burden of dengue fever to guide decision-makers in setting health policy priorities. Methods/Principal findings A standardized cost-of-illness study was conducted in three dengue endemic countries: Vietnam, Thailand, and Colombia. In order to capture all costs during the entire period of illness, patients were tested with rapid diagnostic tests on the first day of their clinical visits, and multiple interviews were scheduled until the patients recovered from the current illness. Various cost items were collected such as direct medical and non-medical costs, indirect costs, and non-out-of-pocket costs. In addition, socio-economic factors affecting disease severity were also identified by adopting a logit model. We found that total cost per episode ranges from $141 to $385 for inpatient and from $40 to $158 outpatient, with Colombia having the highest and Thailand having the lowest. The percentage of the private economic burden of dengue fever was highest in the low-income group and lowest in the high-income group. The logit analyses showed that early treatment, higher education, and better knowledge of dengue disease would reduce the probability of developing more severe illness. Conclusions/Significance The cost of dengue fever is substantial in the three dengue endemic countries. Our study findings can be used to consider accelerated introduction of vaccines into the public and private sector programs and prioritize alternative health interventions among competing health problems. In addition, a community would be better off by propagating the socio-economic factors identified in this study, which may prevent its members from developing severe illness in the long run. Dengue fever has been prevalent in South-East Asia and South America. Despite the increase of dengue fever cases, there continues to be a lack of economic assessment partly due to the absence of vaccines until recent times. Many of the previous economic burden studies for dengue fever were not standardized, making them difficult to compare. We implemented the standardized economic burden survey for dengue fever in a multi-country setting: Vietnam, Thailand, and Colombia. We found that the economic burden of dengue fever is substantial in all three dengue endemic countries. Our study also identified socio-economic factors which are related to the probability of experiencing severe illness. The first live attenuated, tetravalent dengue vaccine (CYD-TDV) has been already licensed in some dengue-endemic countries. As three countries will soon face decisions on whether and how to incorporate current and future vaccine candidates within their budget constraints, the updated economic burden estimates can be used to develop sustainable financing plans.
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El Fezzazi H, Branchu M, Carrasquilla G, Pitisuttithum P, Perroud AP, Frago C, Coudeville L. Resource Use and Costs of Dengue: Analysis of Data from Phase III Efficacy Studies of a Tetravalent Dengue Vaccine. Am J Trop Med Hyg 2017; 97:1898-1903. [PMID: 29141713 PMCID: PMC5805027 DOI: 10.4269/ajtmh.16-0952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A tetravalent dengue vaccine (CYD-TDV) has recently been approved in 12 countries in southeast Asia and Latin America for individuals aged 9–45 years or 9–60 years (age indication approvals vary by country) living in endemic areas. Data on utilization of medical and nonmedical resources as well as time lost from school and work were collected during the active phase of two phase III efficacy studies performed in 10 countries in the Asia-Pacific region and Latin America (NCT01373281; NCT01374516). We compared dengue-related resource utilization and costs among vaccinated and nonvaccinated participants. Country-specific unit costs were derived from available literature. There were 901 virologically confirmed dengue episodes among participants aged ≥ 9 years (N = 25,826): corresponding to 373 episodes in the CYD-TDV group (N = 17,230) and 528 episodes in the control group (N = 8,596). Fewer episodes in the CYD-TDV group resulted in hospitalization than in the control group (7.0% versus 13.3%; P = 0.002), but both had a similar average length of stay of 4 days. Overall, a two-thirds reduction in resource consumption and missed school/work days was observed in the CYD-TDV group relative to the control group. The estimated direct and indirect cost (2014 I$) associated with dengue episodes per participant in the CYD-TDV group was 73% lower than in the control group (I$6.72 versus I$25.08); representing a saving of I$I8.36 (95% confidence interval [CI]:17.05–19.78) per participant with vaccination. This is the first study providing information on dengue costs among vaccinated individuals and direct confirmation that vaccination has the potential to reduce dengue illness costs.
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Affiliation(s)
- Hanna El Fezzazi
- Dengue Vaccination Impact and Economics, Sanofi Pasteur, Lyon, France
| | - Marie Branchu
- Ecole des Hautes Etudes en Santé Publique (EHESP)-ESSEC Business School, Cergy, France
| | | | - Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ana Paula Perroud
- Clinical Research and Development, Sanofi Pasteur, Sâo Paulo, Brazil
| | - Carina Frago
- Clinical Sciences, Sanofi Pasteur, Singapore, Singapore
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Vo NTT, Phan TND, Vo TQ. Direct Medical Costs of Dengue Fever in Vietnam: A Retrospective Study in a Tertiary Hospital. Malays J Med Sci 2017; 24:66-72. [PMID: 28814934 DOI: 10.21315/mjms2017.24.3.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 02/14/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND In Vietnam, dengue fever is a major health concern, yet comprehensive information on its economic costs is lacking. The present study investigated treatment costs associated with dengue fever from the perspective of health care provision. METHODS This retrospective study was conducted between January 2013 and December 2015 in Cu Chi General Hospital. The following dengue-related treatment costs were calculated: hospitalisation, diagnosis, specialised services, drug usage and medical supplies. Average cost per case and treatment cost across different age was calculated. RESULTS In the study period, 1672 patients with dengue fever were hospitalised. The average age was 24.98 (SD = 14.10) years, and 47.5% were males (795 patients). Across age groups, the average cost per episode was USD 48.10 (SD = 3.22). The highest costs (USD 56.61, SD = 48.84) were incurred in the adult age group (> 15 years), and the lowest costs (USD 30.10, SD = 17.27) were incurred in the paediatric age group (< 15 years). CONCLUSION The direct medical costs of dengue-related hospitalisation place a severe economic burden on patients and their families. The probable economic value of dengue management in Vietnam is significant.
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Affiliation(s)
- Nhung Thi Tuyet Vo
- Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City 700000, Vietnam
| | - Trang Ngo Diem Phan
- Department of Pharmacy, Cu Chi General Hospital, Ho Chi Minh City 700000, Vietnam
| | - Trung Quang Vo
- Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City 700000, Vietnam
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Fitzpatrick C, Haines A, Bangert M, Farlow A, Hemingway J, Velayudhan R. An economic evaluation of vector control in the age of a dengue vaccine. PLoS Negl Trop Dis 2017; 11:e0005785. [PMID: 28806786 PMCID: PMC5573582 DOI: 10.1371/journal.pntd.0005785] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 08/28/2017] [Accepted: 07/06/2017] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Dengue is a rapidly emerging vector-borne Neglected Tropical Disease, with a 30-fold increase in the number of cases reported since 1960. The economic cost of the illness is measured in the billions of dollars annually. Environmental change and unplanned urbanization are conspiring to raise the health and economic cost even further beyond the reach of health systems and households. The health-sector response has depended in large part on control of the Aedes aegypti and Ae. albopictus (mosquito) vectors. The cost-effectiveness of the first-ever dengue vaccine remains to be evaluated in the field. In this paper, we examine how it might affect the cost-effectiveness of sustained vector control. METHODS We employ a dynamic Markov model of the effects of vector control on dengue in both vectors and humans over a 15-year period, in six countries: Brazil, Columbia, Malaysia, Mexico, the Philippines, and Thailand. We evaluate the cost (direct medical costs and control programme costs) and cost-effectiveness of sustained vector control, outbreak response and/or medical case management, in the presence of a (hypothetical) highly targeted and low cost immunization strategy using a (non-hypothetical) medium-efficacy vaccine. RESULTS Sustained vector control using existing technologies would cost little more than outbreak response, given the associated costs of medical case management. If sustained use of existing or upcoming technologies (of similar price) reduce vector populations by 70-90%, the cost per disability-adjusted life year averted is 2013 US$ 679-1331 (best estimates) relative to no intervention. Sustained vector control could be highly cost-effective even with less effective technologies (50-70% reduction in vector populations) and in the presence of a highly targeted and low cost immunization strategy using a medium-efficacy vaccine. DISCUSSION Economic evaluation of the first-ever dengue vaccine is ongoing. However, even under very optimistic assumptions about a highly targeted and low cost immunization strategy, our results suggest that sustained vector control will continue to play an important role in mitigating the impact of environmental change and urbanization on human health. If additional benefits for the control of other Aedes borne diseases, such as Chikungunya, yellow fever and Zika fever are taken into account, the investment case is even stronger. High-burden endemic countries should proceed to map populations to be covered by sustained vector control.
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Affiliation(s)
- Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
- * E-mail:
| | - Alexander Haines
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
- National Guideline Centre, Royal College of Physicians, London, United Kingdom
| | - Mathieu Bangert
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Andrew Farlow
- Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Janet Hemingway
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Raman Velayudhan
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Pham LD, Phung NHT, Le NTD, Vo TQ. Economic report on the cost of dengue fever in Vietnam: case of a provincial hospital. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 9:1-8. [PMID: 28031723 PMCID: PMC5179203 DOI: 10.2147/ceor.s124023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dengue is a mosquito-borne viral illness with the world's fastest rate of infection. In 2014, Vietnam had recorded 43,000 cases in 53 provinces, with 28 deaths. MATERIALS AND METHODS A 6-month cross-sectional study was conducted from September 2015 to March 2016 at Cu Chi General Hospital. Cost of illness in this study was estimated under the incidence-based approach from the societal perspective. RESULTS The average cost per case was US$139.3±$61.7. The average cost per child was higher than per adult, but not significant ($151.0±$63.5 and $132.7±$59.9, respectively; P=0.068). Meanwhile, 50.2% of the total cost was contributed by the cost of hospital bed. According to the sensitivity analysis, if both the costs of the hospital bed and ultrasound were reduced by 10%, the total treatment cost of dengue fever would fall by 5% and 1.6%, respectively. CONCLUSION This study is expected to be the basis for investment-plan formulation and fund allocation for the treatment and prevention of dengue. In an attempt to examine the entire socioeconomic encumbrance caused by the dengue virus, a larger scale study targeting both dengue and dengue hemorrhagic fever needs to be conducted in several hospitals.
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Affiliation(s)
- Luyen Dinh Pham
- Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Nhat Huy Tran Phung
- Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Nguyen Tu Dang Le
- Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Trung Quang Vo
- Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
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Constenla D, Garcia C, Lefcourt N. Assessing the Economics of Dengue: Results from a Systematic Review of the Literature and Expert Survey. PHARMACOECONOMICS 2015; 33:1107-1135. [PMID: 26048354 DOI: 10.1007/s40273-015-0294-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The economics of dengue is complex and multifaceted. OBJECTIVES We performed a systematic review of the literature to provide a critical overview of the issues related to dengue economics research and to form a background with which to address the question of cost. METHODS Three literature databases were searched [PubMed, Embase and Latin American and Caribbean Health Sciences Literature (LILACS)], covering a period from 1980 to 2013, to identify papers meeting preset inclusion criteria. Studies were reviewed for methodological quality on the basis of a quality checklist developed for this purpose. An expert survey was designed to identify priority areas in dengue economics research and to identify gaps between the methodology and actual practice. Survey responses were combined with the literature review findings to determine stakeholder priorities in dengue economics research. RESULTS The review identified over 700 papers. Forty-two of these papers met the selection criteria. The studies that were reviewed presented results from 32 dengue-endemic countries, underscoring the importance of dengue as a global public health problem. Cost analyses were the most common, with 21 papers, followed by nine cost-effectiveness analyses and seven cost-of-illness studies, indicating a relatively strong mix of methodologies. Dengue annual overall costs (in 2010 values) ranged from US$13.5 million (in Nicaragua) to $56 million (in Malaysia), showing cost variations across countries. Little consistency exists in the way costs were estimated and dengue interventions evaluated, making generalizations around costs difficult. CONCLUSIONS The current evidence suggests that dengue costs are substantial because of the cost of hospital care and lost earnings. Further research in this area will broaden our understanding of the true economic impact of dengue.
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Affiliation(s)
- Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, 21205, USA.
- Dengue Vaccine Initiative (DVI), Baltimore, USA.
| | - Cristina Garcia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, 21205, USA
| | - Noah Lefcourt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, 21205, USA
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Salmon-Mulanovich G, Blazes DL, Lescano AG, Bausch DG, Montgomery JM, Pan WK. Economic Burden of Dengue Virus Infection at the Household Level Among Residents of Puerto Maldonado, Peru. Am J Trop Med Hyg 2015. [PMID: 26217040 DOI: 10.4269/ajtmh.14-0755] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Dengue virus (DENV) was reintroduced to Peru in the 1990s and has been reported in Puerto Maldonado (population ~65,000) in the Peruvian southern Amazon basin since 2000. This region also has the highest human migration rate in the country, mainly from areas not endemic for DENV. The objective of this study was to assess the proportion of household income that is diverted to costs incurred because of dengue illness and to compare these expenses between recent migrants (RMs) and long-term residents (LTRs). We administered a standardized questionnaire to persons diagnosed with dengue illness at Hospital Santa Rosa in Puerto Maldonado from December 2012 to March 2013. We compared direct and indirect medical costs between RMs and LTRs. A total of 80 participants completed the survey, of whom 28 (35%) were RMs and 52 (65%) were LTRs. Each dengue illness episode cost the household an average of US$105 (standard deviation [SD] = 107), representing 24% of their monthly income. Indirect costs were the greatest expense (US$56, SD = 87), especially lost wages. The proportion of household income diverted to dengue illness did not differ significantly between RM and LTR households. The study highlights the significant financial burden incurred by households when a family member suffers dengue illness.
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Affiliation(s)
- Gabriela Salmon-Mulanovich
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - David L Blazes
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Andres G Lescano
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Daniel G Bausch
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Joel M Montgomery
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - William K Pan
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
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Abstract
Dengue is an expanding public health problem in the tropics and subtropical areas. Millions of people, most from resource-constrained countries, seek treatment every year for dengue-related disease. Despite more than 70 years of effort, a safe and efficacious vaccine remains unavailable. Antidengue antiviral drugs also do not exist despite attempts to develop or repurpose drug compounds. Gaps in the knowledge of dengue immunology, absence of a validated animal or human model of disease, and suboptimal assay platforms to measure immune responses following infection or experimental vaccination are obstacles to drug and vaccine development efforts. The limited success of one vaccine candidate in a recent clinical endpoint efficacy trial challenges commonly held beliefs regarding potential correlates of protection. If a dengue vaccine is to become a reality in the near term, vaccine developers should expand development pathway explorations beyond those typically required to demonstrate safety and efficacy.
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