Research Articles

Using disability-adjusted life years to assess the economic impact of dengue in Puerto Rico: 1984-1994

This study presents the disability-adjusted life years (DALYs), a non-monetary economic measure of impact, lost to dengue in Puerto Rico for the period 1984-1994. Data on the number of reported cases, cases with hemorrhagic manifestations, hospitalizations, and deaths were obtained from a surveillance system maintained at the Dengue Branch, Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention (San Juan, PR). The reported cases were divided into two age groups (0-15 years old and >15 years old), and then multiplied by predetermined factors (10 for 0-15 years; 27 for >15 years) to allow for age-related under-reporting of cases. Severity of dengue was modeled by classifying cases into three groups: dengue fever, dengue with severe manifestations, and hospitalized cases. Each group was assigned a different number of days lost because of dengue-related disability. Dengue caused an average of 658 DALYs per year per million population (SE = 114, range = 145-1,519). A multivariate sensitivity analysis, which simultaneously altered the values of six input variables, produced a mean of 580 DALYs/year/million population, with a maximum average of 1,021 DALYs/year/million population, and a maximum, single-year estimate for 1994 of 2,153 DALYs/million population. The most important input was the number of days lost to classic dengue. The DALYs/year/million population lost to dengue in Puerto Rico are much greater than previous estimates concerning the impact of dengue hemorrhagic fever alone. The loss to dengue is similar to the losses per million population in the Latin American and Caribbean region attributed to any of the following diseases or disease clusters; the childhood cluster (polio, measles, pertussis, diphtheria, tetanus), meningitis, hepatitis, or malaria. The loss is also of the same order of magnitude as any one of the following: tuberculosis, sexually transmitted diseases (excluding human immunodeficiency virus), tropical cluster (e.g., Chagas' disease, leishmaniasis), or intestinal helminths. The results objectively suggest that when governments and international funding agencies allocate resources for research and control, dengue should be given a priority equal to many other infectious diseases that are generally considered more important.

This article has been cited by other articles:

				K. M. Tomashek, A. Rivera, J. L. Munoz-Jordan, E. Hunsperger, L. Santiago, O. Padro, E. Garcia, and W. Sun Description of a Large Island-Wide Outbreak of Dengue in Puerto Rico, 2007 Am J Trop Med Hyg, September 1, 2009; 81(3): 467 - 474. [Abstract] [Full Text] [PDF]

				J. A. Suaya, D. S. Shepard, J. B. Siqueira, C. T. Martelli, L. C. S. Lum, L. H. Tan, S. Kongsin, S. Jiamton, F. Garrido, R. Montoya, et al. Cost of Dengue Cases in Eight Countries in the Americas and Asia: A Prospective Study Am J Trop Med Hyg, May 1, 2009; 80(5): 846 - 855. [Abstract] [Full Text] [PDF]

				B. Armien, J. A. Suaya, E. Quiroz, B. K. Sah, V. Bayard, L. Marchena, C. Campos, and D. S. Shepard Clinical Characteristics and National Economic Cost of the 2005 Dengue Epidemic in Panama Am J Trop Med Hyg, September 1, 2008; 79(3): 364 - 371. [Abstract] [Full Text] [PDF]

				M. M. Ramos, D. F. Arguello, C. Luxemburger, L. Quinones, J. L. Munoz, M. Beatty, J. Lang, and K. M. Tomashek Epidemiological and Clinical Observations on Patients with Dengue in Puerto Rico: Results from the First Year of Enhanced Surveillance--June 2005-May 2006 Am J Trop Med Hyg, July 1, 2008; 79(1): 123 - 127. [Abstract] [Full Text] [PDF]

				S. Shresta, K. L. Sharar, D. M. Prigozhin, P. R. Beatty, and E. Harris Murine Model for Dengue Virus-Induced Lethal Disease with Increased Vascular Permeability. J. Virol., October 1, 2006; 80(20): 10208 - 10217. [Abstract] [Full Text] [PDF]

				D. V. CLARK, M. P. MAMMEN JR., A. NISALAK, V. PUTHIMETHEE, and T. P. ENDY ECONOMIC IMPACT OF DENGUE FEVER/DENGUE HEMORRHAGIC FEVER IN THAILAND AT THE FAMILY AND POPULATION LEVELS Am J Trop Med Hyg, June 1, 2005; 72(6): 786 - 791. [Abstract] [Full Text] [PDF]

				J. T. UTZ, C. S. APPERSON, J. N. MACCORMACK, M. SALYERS, E. J. DIETZ, and J. T. MCPHERSON ECONOMIC AND SOCIAL IMPACTS OF LA CROSSE ENCEPHALITIS IN WESTERN NORTH CAROLINA Am J Trop Med Hyg, November 1, 2003; 69(5): 509 - 518. [Abstract] [Full Text] [PDF]

				A. Blackman and A. Palma Scrap Tires in Ciudad Juarez and El Paso: Ranking the Risks The Journal of Environment Development, September 1, 2002; 11(3): 247 - 266. [Abstract] [PDF]

				F Espinoza-Gomez, C Moises Hernandez-Suarez, and R Coll-Cardenas Educational campaign versus malathion spraying for the control of Aedes aegypti in Colima, Mexico J Epidemiol Community Health, February 1, 2002; 56(2): 148 - 152. [Abstract] [Full Text] [PDF]