1921
Volume 86, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Dengue, endemic in Puerto Rico, reached a record high in 2010. To inform policy makers, we derived annual economic cost. We assessed direct and indirect costs of hospitalized and ambulatory dengue illness in 2010 dollars through surveillance data and interviews with 100 laboratory-confirmed dengue patients treated in 2008–2010. We corrected for underreporting by using setting-specific expansion factors. Work absenteeism because of a dengue episode exceeded the absenteeism for an episode of influenza or acute otitis media. From 2002 to 2010, the aggregate annual cost of dengue illness averaged $38.7 million, of which 70% was for adults (age 15+ years). Hospitalized patients accounted for 63% of the cost of dengue illness, and fatal cases represented an additional 17%. Households funded 48% of dengue illness cost, the government funded 24%, insurance funded 22%, and employers funded 7%. Including dengue surveillance and vector control activities, the overall annual cost of dengue was $46.45 million ($12.47 per capita).

[open-access] This is an Open Access article distributed under the terms and of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.2012.11-0784
2012-05-01
2019-01-17
Loading full text...

Full text loading...

/deliver/fulltext/14761645/86/5/745.html?itemId=/content/journals/10.4269/ajtmh.2012.11-0784&mimeType=html&fmt=ahah

References

  1. Centers for Disease Control and Prevention, Division of Vector Borne Diseases, 2011. Dengue: Entomology and Ecology. Available at: http://www.cdc.gov/dengue/entomologyEcology/index.html. Accessed September 7, 2011. [Google Scholar]
  2. Farrar J, Focks D, Gubler D, Barrera R, Guzman MG, Simmons C, Kalayanarooj S, Lum L, McCall PJ, Lloyd L, Horstick O, Dayal-Drager R, Nathan MB, Kroeger A, , 2007. Towards a global dengue research agenda. Trop Med Int Health 12: 695699.[Crossref] [Google Scholar]
  3. Guzman A, Isturiz RE, , 2010. Update on the global spread of dengue. Int J Antimicrob 36S: S40S42.[Crossref] [Google Scholar]
  4. Guha-Sapir D, Schimmer B, , 2005. Dengue fever: new paradigm for changing epidemiology. Emerg Themes Epidemiol 2: 110.[Crossref] [Google Scholar]
  5. Whitehorn J, Farrar J, , 2010. Dengue. Br Med Bull 95: 161173.[Crossref] [Google Scholar]
  6. World Health Organization (WHO), 2009. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control—New Edition. Geneva, Switzerland: UNICEF, UNDP, World Bank, WHO. [Google Scholar]
  7. Singhasivanon P, Jacobson J, , 2009. Dengue is a major global health problem. Foreword. J Clin Virol 46: S1S2.[Crossref] [Google Scholar]
  8. Gubler DJ, , 2011. Emerging vector-borne flavivirus diseases: are vaccines the solution? Vaccine 10: 563565. [Google Scholar]
  9. Guzman MG, Halstead SB, Artsob H, Buchy P, Farrar J, Gubler DJ, Hunsperger E, Kroeger A, Margolis HS, Martínez E, Nathan MB, Pelegrino JL, Simmons C, Yoksan S, Peeling RW, , 2010. Dengue: a continuing global threat. Nat Rev Microbiol 8: S7S16.[Crossref] [Google Scholar]
  10. Beatty M, Beutels P, Meltzer MI, Shepard DS, Hombach J, Hutubessy R, Dessis D, Coudeville L, Dervaux B, Wichmann O, Margolis HS, Kuritsky JN, , 2011. Health economics of dengue a systematic literature review and expert panel's assessment. Am J Trop Med Hyg 84: 473488.[Crossref] [Google Scholar]
  11. Kyle JL, Harris E, , 2008. Global spread and persistence of dengue. Annu Rev Microbiol 62: 7192.[Crossref] [Google Scholar]
  12. Suaya JA, Shepard DS, Siqueira JB, Martelli CT, Lum LCS, Tan LH, Kongsin S, Jiamton S, Garrido F, Montaya R, Armien B, Huy R, Castillo L, Sah BK, Sughayyar R, Tyo KR, Halsted SB, , 2009. Cost of dengue cases in eight countries in Americas and Asia, a prospective study. Am J Trop Med Hyg 80: 845855. [Google Scholar]
  13. World Health Organization Media Center, 2009. Dengue and Dengue Haemorrhagic Fever, Fact Sheet No. 117. Available at: http://www.who.int/mediacentre/factsheets/fs117/en/index.html. Accessed December 10, 2009. [Google Scholar]
  14. World Health Organization (WHO), 2006. Report of the Scientific Working Group on Dengue. Geneva, Switzerland: World Health Organization. [Google Scholar]
  15. Hemungkorn M, Thisyakorn U, Thisyakorn C, , 2007. Dengue infection: a growing global health threat. Biosci Trends 1: 9096. [Google Scholar]
  16. Halstead SB, , 1988. Pathogenesis of dengue: challenges to molecular biology. Science 239: 476481.[Crossref] [Google Scholar]
  17. Webster DP, Farrar J, Rowland-Jones S, , 2009. Progress towards a dengue vaccine. Lancet Infect Dis 9: 678687.[Crossref] [Google Scholar]
  18. Isturiz RE, Gubler DJ, Castillo JB, , 2000. Dengue and dengue hemorrhagic fever in Latin America and the Caribbean. Infect Dis Clin North Am 14: 121140.[Crossref] [Google Scholar]
  19. Nishiura H, , 2008. Duration of short-lived cross-protection immunity against a clinical attack of dengue: a preliminary estimate. Dengue Bull 32: 5566. [Google Scholar]
  20. Halstead SB, , 2003. Neutralization and antibody-dependent enhancement of dengue viruses. Adv Virus Res 60: 421467.[Crossref] [Google Scholar]
  21. Kliks SC, Nisalak A, Brandt WE, Wahl L, Burke DS, , 1989. Antibody-dependent enhancement of dengue virus growth in human monocytes as a risk factor for dengue hemorrhagic fever. Am J Trop Med Hyg 40: 444451. [Google Scholar]
  22. Schieffelin JS, Costin JM, Nicholson CO, Orgeron NM, Fontaine KA, Isern S, Michael SF, Robinson JE, , 2010. Neutralizing and non-neutralizing monoclonal antibodies against dengue virus E protein derived from a naturally infected patient. Virol J 7: 28.[Crossref] [Google Scholar]
  23. Wilder-Smith A, Ooi EE, Vasudevan SG, Gubler DJ, , 2010. Update on dengue: epidemiology, virus evolution, antiviral drugs, and vaccine development. Curr Infect Dis Rep 12: 157164.[Crossref] [Google Scholar]
  24. Morens DM, Fauci AS, , 2008. Dengue and hemorrhagic fever: a potential threat to public health in the United States. JAMA 299: 214216.[Crossref] [Google Scholar]
  25. Departamento de Salud Gobierno de Puerto Rico, CDC Dengue Branch, 2011. Informe Semanal de Vigilancia de Dengue. Available at: http://www.salud.gov.pr/Datos/VDengue/DengueInfo/Pages/DatosEstadisticos.aspx. Accessed September 7, 2011. [Google Scholar]
  26. Centers for Disease Control Dengue Branch, Puerto Rico Department of Health, 2010. Dengue Update. Available at: http://www.cdc.gov/Dengue/dengue_upd/index.html. Accessed May 11, 2011. [Google Scholar]
  27. Perez-Guerra C, Halasa Y, Rivera R, Peña M, Ramírez V, Cano MP, Shepard DS, , 2010. Economic cost of dengue public prevention activities in Puerto Rico. Dengue Bull 34: 1323. [Google Scholar]
  28. Rigau-Perez JG, Clark GG, , 2005. How to respond to a dengue epidemic: overview and experience in Puerto Rico. Rev Panam Salud Publica 17: 282293.[Crossref] [Google Scholar]
  29. Winch P, Leontsini E, Rigau-Perez JG, Ruiz-Perez M, Clark GG, Gubler DJ, , 2002. Community-based dengue prevention programs in Puerto Rico: impact on knowledge, behavior, and residential mosquito infestation. Am J Trop Med Hyg 67: 363370. [Google Scholar]
  30. Tomashek KM, Rivera A, Munoz-Jordan JL, Hunsperger E, Santiago L, Padro O, Garcia E, Sun W, , 2009. Description of a large island-wide outbreak of dengue in Puerto Rico, 2007. Am J Trop Med Hyg 81: 467474. [Google Scholar]
  31. Von Allmen SD, Lopez-Correa RH, Woodall JP, Morens DM, Chiriboga J, Casta-Velez A, , 1979. Epidemic dengue fever in Puerto Rico, 1977: a cost analysis. Am J Trop Med Hyg 28: 10401044. [Google Scholar]
  32. Rodriguez E, , 1997. Dengue Outbreak in Puerto Rico (1994–95): Hospitalization Cost Analysis. Geneva, Switzerland: World Health Organization. [Google Scholar]
  33. Centers for Disease Control and Prevention/Division of Vector Borne and Infectious Diseases, 2011. Dengue in Puerto Rico. Available at: http://www.cdc.gov/dengue/about/inPuerto.html. Accessed January 9, 2011. [Google Scholar]
  34. World Health Organization (WHO), 1997. Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. Geneva, Switzerland: World Health Organization. [Google Scholar]
  35. Hayashi AS, Finnegan B, Shin P, Jones E, Rosenbaum S, , 2009. Examining the Experiences of Puerto Rico's Community Health Centers under the Government Health Insurance Plan, Policy Research Brief No. 8. Washington, DC: George Washington University School of Public Health and Health Services. [Google Scholar]
  36. US Census Bureau, 2003. School Enrollment 2000. Table 1. Population Aged 3 and Over by Enrollment Status and Level for the United States, Regions, States, and for Puerto Rico: 1990 and 2000. Available at: http://www.census.gov/prod/2003pubs/c2kbr-26.pdf. Accessed January 19, 2011. [Google Scholar]
  37. Central Intelligence Agency, 2008. Federal and State Minimum Wage Rates, Laws, and Resources. Available at: http://www.minimum-wage.org/states.asp?state=Puerto%20Rico. Accessed January 20, 2011. [Google Scholar]
  38. Dechant EJ, Rigau-Perez JG, Puerto Rico Association of Epidemiologists, 1999. Hospitalizations for suspected dengue in Puerto Rico, 1991–1995: estimation by capture-recatpure methods. Am J Trop Med Hyg 61: 574578. [Google Scholar]
  39. Meltzer MI, Rigau-Perez JG, Clark GG, Reiter P, Gubler DJ, , 1998. Using disability-adjusted life years to assess the economic impact of dengue in Puerto Rico: 1984–1994. Am J Trop Med Hyg 59: 265271. [Google Scholar]
  40. Ramos MM, Argüello DF, Luxemburger C, Quiñones L, Muñoz JL, Beatty M, Lang J, Tomashek KM, , 2008. 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 79: 123127. [Google Scholar]
  41. Perez-Guerra C, Zielinski-Gutierrez E, Vargas-Torres D, Clark G, , 2009. Community beliefs and practices about dengue in Puerto Rico. Rev Panam Salud Publica 25: 218226.[Crossref] [Google Scholar]
  42. Rivera A, Tomashek KM, Munoz J, Hunsperger E, Blau D, Sharp T, Torres J, Infectious Diseases Pathology Branch Gonzalez L, Deseda C, Rivera I, Sanabria D, Torres J, Rodriguez R, Serrano J, Davila F, Lopez D, Margolis H, , 2011. Enhanced Surveillance for Fatal Dengue in Puerto Rico. Presented at the American Society of Tropical Medicine and Hygiene 60th Annual Meeting. Philadelphia, PA, December 4–8, Abstract 1335. [Google Scholar]
  43. US Social Security Administration, Actuarial Publications, Period Life Table, 2007. Available at: http://www.ssa.gov/oact/STATS/table4c6.html. Accessed November 1, 2011. [Google Scholar]
  44. Neff JM, Morris L, Gonzalez-Alcover R, Coleman PH, Lyss SB, Negron H, , 1967. Dengue fever in a Puerto Rican community. Am J Epidemiol 86: 162184.[Crossref] [Google Scholar]
  45. Welcome to Puerto Rico, 2006. Economy. Available at: http://www.topuertorico.org/economy.shtml. Accessed October 21, 2010. [Google Scholar]
  46. Akazawa M, Sindelar JL, Paltiel AD, , 2003. Economic costs of influenza-related work absenteeism. Value Health 6: 107115.[Crossref] [Google Scholar]
  47. Keech M, Beardsworth P, , 2008. The impact of influenza on working days lost: a review of the literature. Pharmacoeconomics 26: 911924.[Crossref] [Google Scholar]
  48. Niemela M, Uhari M, Mottonen M, Pokka T, , 1999. Costs arising from otitis media. Acta Paediatr 88: 553556.[Crossref] [Google Scholar]
  49. Greenberg D, Bilenko N, Liss Z, Shagan T, Zamir O, Dagan R, , 2003. The burden of acute otitis media on the patient and the family. Eur J Pediatr 162: 576581.[Crossref] [Google Scholar]
  50. Anderson KB, Chunsuttiwat S, Nisalak A, Mammen MP, Jr Libraty DH, Rothman AL, Green S, Vaughn DW, Ennis FA, Endy TP, , 2007. Burden of symptomatic dengue infection in children at primary school in Thailand: a prospective study. Lancet 369: 14521459.[Crossref] [Google Scholar]
  51. Añez G, Balza R, Valero N, Larreal Y, , 2006. Impacto económico del dengue y del dengue hemorrágico en el Estado de Zulia, Venezuela, 1997–2003. Rev Panam Salud Publica 19: 314320.[Crossref] [Google Scholar]
  52. Armien B, Suaya JA, Quiroz E, Sah BK, Bayard V, Marchena L, Campos C, Shepard DS, , 2008. Clinical characteristics and national economic cost of the 2005 dengue epidemic in Panama. Am J Trop Med Hyg 79: 364371. [Google Scholar]
  53. Canyon DV, , 2008. Historical analysis of the economic cost of dengue in Australia. J Vector Dis 45: 245248. [Google Scholar]
  54. Chandralekha GP, Trikha A, , 2008. The north Indian dengue outbreak 2006: a retrospective analysis of intensive care unit admissions in a tertiary care hospital. Trans R Soc Trop Med Hyg 102: 143147.[Crossref] [Google Scholar]
  55. Clark DV, Mammen MP, Jr Nisalak A, Puthimethee V, Endy TP, , 2005. Economic impact of dengue fever/dengue hemorrhagic fever in Thailand at the family and population levels. Am J Trop Med Hyg 72: 786791. [Google Scholar]
  56. Coudeville L, Shepard DS, Zambrano B, Dayan G, , 2009. Dengue Economic Burden in the Americas: Estimates from Dengue Illness. Washington, DC. Presented at the American Society of Tropical Medicine and Hygiene 58th Annual Meeting, Washington, DC, November 18–22, poster 442. [Google Scholar]
  57. Garg P, Nagpal J, Kairnar P, Sinveratne SL, , 2008. Economic burden of dengue infections in India. Trans R Soc Trop Med Hyg 102: 570577.[Crossref] [Google Scholar]
  58. Huy R, Wichmann O, Beatty M, Ngan C, Duong S, Margolis HS, Vong S, , 2009. Cost of dengue and other febrile illnesses to households in rural Cambodia: a prospective community-based case-control study. BMC Public Health 9: 155.[Crossref] [Google Scholar]
  59. Torres JR, Castro J, , 2007. The health and economic impact of dengue in Latin America 1. Cad Saude Publica 23 (Suppl 1): S23S31. [Google Scholar]
  60. Valdés LG, Mizhrahi JV, Guzmáán MG, , 2002. Impacto económico de la epidemia de dengue 2 en Santiago de Cuba, 1997. Rev Cubana Med Trop 54: 220227. [Google Scholar]
  61. Kongsin S, Jaimton S, Suaya J, Vasanawathana S, Sirisuvan P, Shepard DS, , 2010. Cost of dengue in Thailand. Dengue Bull 34: 7788. [Google Scholar]
  62. Pan American Health Organization (PAHO), Fact Sheet: Dengue. Available at: http://new.paho.org/hq/index.php?option=com_content&task=view&id=264&Itemid=363&lang=en. Accessed November 1, 2011. [Google Scholar]
  63. Allwinn R, Hofknecht N, Doerr HW, , 2008. 12 Denue in travelers is still underestimated. Intervirology 12: 695699. [Google Scholar]
  64. LaRouche G, Renaudat C, Tarantola A, Caro V, Ledrans M, Dejour-Salamanca D, Diancourt L, Tolou H, Grandadam M, Gastellu-Etchegorry M, , 2010. Increase in dengue fever imported from Cote d'Ivoire and West Africa to France. Dengue Bull 34: 2431. [Google Scholar]
  65. World Health Organization (WHO), 2010. Weekly Epidemiological Monitor. Cairo, Egypt: Regional Office of the Eastern Mediterranean. [Google Scholar]
  66. Mavalankar D, Puwar T, Murtola T, Vasan S, Field R, Alphey N, Gong H-F, Shepard DS, , 2009. Quantifying the Impact of Chikungunya and Dengue on Tourism Revenues. W.P.No. 2009-02-03. Ahmedabad, India: Indian Institute of Management Working Paper Series. Available at: http://www.iimahd.ernet.in/publications/data/2009-02-03Mavalankar.pdf. Accessed July 30, 2009. [Google Scholar]
  67. Pan American Health Organization (PAHO), 2007. Health Systems Profile Puerto Rico: Monitoring and Analysis Health Systems Change/Reform. Washington, DC: Pan American Health Organization and USAID. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2012.11-0784
Loading
/content/journals/10.4269/ajtmh.2012.11-0784
Loading

Data & Media loading...

  • Received : 18 Dec 2011
  • Accepted : 15 Feb 2012

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error