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Cost of Dengue Cases in Eight Countries in the Americas and Asia: A Prospective Study

Despite the growing worldwide burden of dengue fever, the global economic impact of dengue illness is poorly documented. Using a common protocol, we present the first multicountry estimates of the direct and indirect costs of dengue cases in eight American and Asian countries. We conducted prospective studies of the cost of dengue in five countries in the Americas (Brazil, El Salvador, Guatemala, Panama, and Venezuela) and three countries in Asia (Cambodia, Malaysia, and Thailand). All studies followed the same core protocol with interviews and medical record reviews. The study populations were patients treated in ambulatory and hospital settings with a clinical diagnosis of dengue. Most studies were performed in 2005. Costs are in 2005 international dollars (I$). We studied 1,695 patients (48% pediatric and 52% adult); none died. The average illness lasted 11.9 days for ambulatory patients and 11.0 days for hospitalized patients. Among hospitalized patients, students lost 5.6 days of school, whereas those working lost 9.9 work days per average dengue episode. Overall mean costs were I$514 and I$1,394 for an ambulatory and hospitalized case, respectively. With an annual average of 574,000 cases reported, the aggregate annual economic cost of dengue for the eight study countries is at least I$587 million. Preliminary adjustment for under-reporting could raise this total to $1.8 billion, and incorporating costs of dengue surveillance and vector control would raise the amount further. Dengue imposes substantial costs on both the health sector and the overall economy.

Received September 22, 2008. Accepted for publication January 13, 2009.

Acknowledgments: We thank all the site research groups for careful study implementation and Martha Baez, Elizabeth HaileSelassie, Clare L. Hurley, Aung Lwin, Ali MacLean, Chrisann Newransky, and William B. Stason from Brandeis University, Moh Seng Chang from WHO Cambodia, and PDVI officials for thoughtful comments.

Financial Support: This research was supported by research agreements from the Pediatric Dengue Vaccine Initiative (PDVI) (a program of the International Vaccine Institute) to the authors’ institutions and by the endowment of the Schneider Institutes for Health Policy at Brandeis University.

Disclosure: The views expressed in this article are those of the authors and do not necessarily reflect the views of the authors’ institutions or the sponsor. This analysis was completed while J. Suaya was a full-time employee at Brandeis University; he is currently working at GlaxoSmithKline on activities unrelated to dengue. D. Shepard is the principal investigator of a grant to Brandeis University from Sanofi Pasteur for a dengue study in a country not included in this manuscript. This grant began after all analyses reported in this manuscript were completed. This statement is made in the interest of full disclosure and not because the authors consider this a conflict of interest.

^* Address correspondence to Jose A. Suaya, Schneider Institutes for Health Policy, Heller School, MS 035, Brandeis University, Waltham, MA 02454-9110. E-mail: Suaya{at}Brandeis.edu

Authors’ addresses: Jose A. Suaya and Mariana Caram, Schneider Institutes for Health Policy, Heller School, MS 035, Brandeis University, Waltham, MA 02454-9110, Tel: +1-781-736-3904, Fax: +1-781-736-1905, E-mails: jsuaya{at}brandeis.edu and mcaram{at}brandeis.edu. Donald S. Shepard, Schneider Institutes for Health Policy Heller School, MS 035, Brandeis University, Waltham, MA 02454-9110, Tel: +1-781-736-3975, Fax: +1-888-429-2672, E-mail: shepard{at}brandeis.edu. João Bosco Siqueira and Celina T. Martelli, Institute of Tropical Pathology and Public Health, Department of Public Health, Federal University of Goiás, Rua Delenda Resende de Mello S/N. Setor Universitário, CEP:74605-050 Goiânia-Goiás, Brazil, Tel: (55 62) 202-0605, E-mails: siqueirajb{at}gmail.com and celina{at}iptsp.ufg.br. Lucy Chai See Lum, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia, Tel: +60-3-7949-2192, +60-3-7949-2428, Fax: +60-3-7955-6114, E-mails: lumcs{at}ummc.edu.my or lucylum{at}gmail.com. Lian Huat Tan, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia, Tel: +60-3-7949-2192, +60-3-7949-2428, Fax: +60-3-7955-6114, E-mail: hutan07{at}gmail.com. Sukhontha Kongsin, Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, Thailand, Tel: +66-2354-8543-49 ext 1124, Fax: +66-2644-8833, E-mail: phsks{at}mahidol.ac.th. Sukhum Jiamton, Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, Tel: +66-2419-7000 ext 4323, Fax: +66-2411-5031, E-mail: sisjt{at}mahidol.ac.th. Fàtima Garrido, Ministry of Health and Social Development, Caracas, Venezuela, E-mail: fatimill{at}yahoo.com. Romeo Montoya, Ministry of Health and Social Assistance, San Salvador, El Salvador, E-mail: montoyarh{at}els.ops-oms.org. Blas Armien, Department of Genomics and Proteomics, Instituto Conmemorativo Gorgas de Estudio de la Salud de Panamá, Panamá, Tel: +507-527-4838, Fax: +507-527-4869, E-mails: barmien{at}gorgas.gob.pa or blasarmien{at}yahoo.com.mx. Rekol Huy, Epidemiologist, National Center for Parasitology, Entomology and Malaria Control, No. 372, Blvd. Monivong, Corner Street 322, Phnom Penh, Cambodia, Tel: +855-23-219271, Fax: +855-23-219271, E-mail: Rekolh{at}cnm.gov.kh. Leticia Castillo, National Health Laboratory, Guatemala City, Guatemala, E-mail: leticiadel-carmen{at}gmail.com. Binod K. Sah, Rama Sughayyar, and Karen R. Tyo, Schneider Institutes for Health Policy, Heller School, MS 035, Brandeis University, Waltham, MA 02454-9110, Tel: +1-781-736-3904, Fax: +1-781-736-3905, E-mails: bsah{at}brandeis.edu, rana{at}brandeis.edu, and karentyo{at}brandeis.edu. Scott B. Halstead, International Vaccine Institute, Pediatric Dengue Vaccine Initiative, Seoul, Korea, Tel: +1-301-984-8704, E-mail: halsteads{at}erols.com.