Volume 87, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Dengue represents a substantial burden in many tropical and sub-tropical regions of the world. We estimated the economic burden of dengue illness in Malaysia. Information about economic burden is needed for setting health policy priorities, but accurate estimation is difficult because of incomplete data. We overcame this limitation by merging multiple data sources to refine our estimates, including an extensive literature review, discussion with experts, review of data from health and surveillance systems, and implementation of a Delphi process. Because Malaysia has a passive surveillance system, the number of dengue cases is under-reported. Using an adjusted estimate of total dengue cases, we estimated an economic burden of dengue illness of US$56 million (Malaysian Ringgit MYR196 million) per year, which is approximately US$2.03 (Malaysian Ringgit 7.14) per capita. The overall economic burden of dengue would be even higher if we included costs associated with dengue prevention and control, dengue surveillance, and long-term sequelae of dengue.

[open-access] This is an Open Access article distributed under the terms 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.


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  1. Guzman A, Isturiz RE, , 2010. Update on the global spread of dengue. Int J Antimicrob Agents 36: S40S42.[Crossref]
  2. Ooi EE, Goh KT, Gubler DJ, , 2006. Denque prevention and 35 years of vector control in Singapore. Emerg Infect Dis 12: 887893.[Crossref]
  3. Halstead SB, , 2007. Dengue. Lancet 370: 16441652.[Crossref]
  4. Gubler DJ, Meltzer M, , 1999. Impact of dengue/dengue hemorrhagic fever on the developing world. Advances in Virus Research. Volume 53. San Diego, CA: Academic Press Inc, 3570.
  5. Shepard DS, Suaya JA, Preedy VR, Watson RR, , 2009. Cost-Effectiveness of a dengue vaccine in Southeast Asia and Panama: preliminary estimates. , eds. Handbook of Disease Burdens and Quality of Life Measures. New York: Springer, 12811296.
  6. Kongsin S, Jiamton S, Suaya J, Vasanawathana S, Sirisuvan P, Shepard D, , 2010. Cost of dengue in Thailand. Dengue Bull 34: 7788.
  7. Suaya JA, Shepard DS, Siqueira JB, Martelli CT, Lum LCS, Tan LH, Kongsin S, Jiamton S, Garrido F, Montoya R, Armien B, Huy R, Castillo L, Caram M, Sah BK, Sughayyar R, Tyo KR, Halstead SB, , 2009. Cost of dengue dases in eight countries in the Americas and Asia: a prospective study. Am J Trop Med Hyg 80: 846855.
  8. Ooi EE, Gubler DJ, , 2009. Dengue in Southeast Asia: epidemiological characteristics and strategic challenges in disease prevention. Cad Saude Publica 25: S115S124.[Crossref]
  9. Holmes EC, Tio PH, Perera D, Muhi J, Cardosa J, , 2009. Importation and co-circulation of multiple serotypes of dengue virus in Sarawak, Malaysia. Virus Res 143: 15.[Crossref]
  10. Poovaneswari S, , 1993. Dengue situation in Malaysia. Malays J Pathol 15: 37.
  11. Lum LCS, Suaya JA, Tan LH, Sah BK, Shepard DS, , 2008. Quality of life of dengue patients. Am J Trop Med Hyg 78: 862867.
  12. Ministry of Health Malaysia, 2010. Vector Borne Disease Control Section. Available at: http://www.dph.gov.my/vektor/eng/kes_dd_tahunan.htm. Accessed May 1, 2010.
  13. World Health Organization, 2010. Data Query by Country—Global Health Atlas: Denguenet. Geneva: World Health Organization.
  14. International Monetary Fund, 2011. World Economic Outlook Database. World Economic and Financial Surveys. Washington, DC: International Money Fund.
  15. Lim LH, Vasan SS, Birgelen L, Murtola TM, Gong H-F, Field RW, Mavalankar DV, Ahmad NW, Hakim LS, Murad S, Wan NC, Lum LC, Suaya JA, Shepard DS, , 2010. Immediate cost of dengue to Malaysia and Thailand: an estimate. Dengue Bull 34: 6576.
  16. Shepard DS, Coudeville L, Halasa YA, Zambrano B, Dayan GH, , 2011. Economic impact of dengue illness in the Americas. Am J Trop Med Hyg 84: 200207.[Crossref]
  17. Vong S, Ngan C, Buchy P, Khieu V, Huy R, Duong V, Ong S, Duong S, Chang MS, Xu ZY, Margolis HS, , 2007. Estimating the incidence of dengue fever in Cambodia: results of a capture recapture analysis. Am J Trop Med Hyg 77: 26.
  18. Chairulfatah A, Setiabudi D, Agoes R, van Sprundel M, Colebunders R, , 2001. Hospital based clinical surveillance for dengue haemorrhagic fever in Bandung, Indonesia 1994–1995. Acta Trop 80: 111115.[Crossref]
  19. Wichmann O, Yoon IK, Vong S, Limkittikul K, Gibbons RV, Mammen MP, Ly S, Buchy P, Sirivichayakul C, Buathong R, Huy R, Letson GW, Sabchareon A, , 2011. Dengue in Thailand and Cambodia: an assessment of the degree of underrecognized disease burden based on reported cases. PLoS Negl Trop Dis 5: e996.[Crossref]
  20. Vong S, Khieu V, Glass O, Ly S, Duong V, Huy R, Ngan C, Wichmann O, Letson GW, Margolis HS, Buchy P, , 2010. Dengue incidence in urban and rural Cambodia: results from population-based active fever surveillance, 2006–2008. PLoS Negl Trop Dis 4: e903.[Crossref]
  21. Undurraga EA, Halasa YA, Shepard DS, , 2011. Expansion factors: a key step in estimating dengue burden and costs in Southeast Asia. Am J Trop Med Hyg 85: 318.[Crossref]
  22. Gubler DJ, , 2002. How effectively is epidemiological surveillance used for dengue programme planning and epidemic response? Dengue Bull 26: 96106.
  23. Ooi EE, Gubler DJ, Nam VS, , 2007. Dengue research needs related to surveillance and emergency response. Report of the Scientific Working Group Meeting on Dengue. Geneva, October 1–5, 2006, 124133.
  24. Deen JL, Harris E, Wills B, Balmaseda A, Hammond SN, Rocha C, Dung NM, Hung NT, Hien TT, Farrar JJ, , 2006. The WHO dengue classification and case definitions: time for a reassessment. Lancet 368: 170173.[Crossref]
  25. World Health Organization—Regional Office for South-East Asia, 2011. Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever. Revised and Expanded. Geneva: World Health Organization, 67.
  26. Shepard D, Lees R, Ng CW, Undurraga EA, Halasa YA, Lum L, , 2011. Burden of dengue in Malaysia: Report from Ministry of Health Workshop. December 6, 2010, Putrajaya, Malaysia: Schneider Institutes for Health Policy, Brandeis University, & University of Malaya. Available at: http://people.brandeis.edu/∼shepard/dengue_in_Malaysia_V42.pdf. Accessed August 1, 2012.
  27. Decisioneering Inc, 2001. Crystal Ball 2000.2. User Manual. Denver, CO: Decisioneering Inc.
  28. X-Rates, 2011. Currency Calculator. Available at: http://www.x-rates.com/. Accessed March 18, 2011.
  29. Clark DV, Mammen MP, 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.
  30. Garg P, Nagpal J, Khairnar P, Seneviratne SL, , 2008. Economic burden of dengue infections in India. Trans R Soc Trop Med Hyg 102: 570577.[Crossref]
  31. Anderson KB, Chunsuttiwat S, Nisalak A, Mammen MP, 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]
  32. Endy TP, Chunsuttiwat S, Nisalak A, Libraty DH, Green S, Rothman AL, Vaughn DW, Ennis FA, , 2002. Epidemiology of inapparent and symptomatic acute dengue virus infection: a prospective study of primary school children in Kamphaeng Phet, Thailand. Am J Epidemiol 156: 4051.[Crossref]
  33. FOMEMA, 2010. FOMEMA: Caring for Malaysia. Available at: http://hugelane.com/Fomema%20Corporate%20Website.htm. Accessed August 1, 2012.
  34. Leong CC, , 2006. Pre-employment medical examination of Indonesian domestic helpers in a private clinic in Johor Bahru. An eight year review. Med J Malaysia 5: 592598.
  35. United States Department of State, 2010. Background Note: Malaysia. Available at: http://www.state.gov/r/pa/ei/bgn/2777.htm. Accessed December 24, 2010.
  36. Leng CH, , 2006. The Emergence of a Transnational Healthcare Service Industry in Malaysia. Working Paper Series. Singapore: Asia Research Institute, National University of Singapore.
  37. Guzman MG, Jaenisch T, Gaczkowski R, Vo TT, Sekaran SD, Kroeger A, Vazquez S, Ruiz D, Martinez E, Mercado JC, Balmaseda A, Harris E, Dimano E, Leano PS, Yoksan S, Villegas E, Benduzu H, Villalobos I, Farrar J, Simmons CP, , 2010. Multi-country evaluation of the sensitivity and specificity of two commercially-available NS1 ELISA assays for dengue diagnosis. PLoS Negl Trop Dis 4: pii: e811.[Crossref]
  38. Dussart P, Petit L, Labeau B, Bremand L, Leduc A, Moua D, Matheus S, Baril L, , 2008. Evaluation of two new commercial tests for the diagnosis of acute dengue virus infection using NS1 antigen detection in human serum. PLoS Negl Trop Dis 2: pii: e280.[Crossref]
  39. Ministry of Health Malaysia, 2009. Health Facts 2008. Kuala Lumpur, Malaysia: Health Informatics Center, Planning and Development Division, 12.
  40. Ministry of Health Malaysia Center HI, , 2010. Health Facts 2009. , ed: Kuala Lumpur, Malaysia: Health Informatics Center, Planning and Development Division, 14.
  41. Delbecq AL, Van de Ven AH, Gustafson DH, , 1975. Group Techniques for Program Planning: A Guide to Nominal Group and Delphi Processes. Glenview, IL: Scott, Foresman and Company.
  42. Shepard DS, Hodgkin D, Anthony YE, , 2000. Analysis of Hospital Costs: A Manual for Managers. Geneva: World Health Organization.
  43. Sabrina AR, , 2006. Unit cost of patient care in district hospitals in the Ministry of Health, Malaysia. Kuala Lumpur, Malaysia: Department of Social and Preventive Medicine, Faculty of Medicine. University of Malaya.
  44. World Health Organization, 2011. Choosing Interventions that are Cost Effective (WHO-CHOICE). Available at: http://www.who.int/choice/en/. Accessed January 2011.
  45. Lim KJ, , 1995. Costing of OPD Services at Main Health Clinics. Kedah Darul Aman. Malaysia: Ministry of Health.
  46. Institute of Public Health, 1996. The National Health and Morbidity Survey II (NHMS II). Kuala Lumpur, Malaysia: Ministry of Health Malaysia.
  47. Drummond MF, Sculpher MJ, Torrance G, O'Brien BJ, Stoddart GL, , 2005. Methods for the Economic Evaluation of Health Care Programmes. New York: Oxford University Press.
  48. Berita National Malaysia (Bernama), January 12, 2011. Minimum Wage Ruling for Security Guards Takes Effect. The Star Online. Kuala Lumpur, Malaysia. Available at: http://thestar.com.my/news/story.asp?file=/2011/1/12/nation/20110112151455&sec=nation. Accessed August 1, 2012.
  49. Anis MN, , February 14, 2011. Single Minimum Wage Proposal for All Sectors, Locals and Foreign Workers. The Star Online. Kuala Lumpur, Malaysia. Available at: http://thestar.com.my/news/story.asp?sec=nation&file=/2011/2/14/nation/20110214163954. Accessed August 1, 2012.
  50. World Health Organization WHO, 2008. Guide for Standardization of Economic Evaluations of Immunization Programmes. Initiative for Vaccine Research, Immunizations, Vaccines and Biologicals. Geneva: World Health Organization, 116.
  51. World Health Organization, 2009. Life Tables for WHO Member States for Year 2009. Available at: http://www.who.int/healthinfo/statistics/mortality_life_tables/en/. Accessed September 22, 2011.
  52. Dinh TT, Le TT, Tran TH, Nguyen TH, Nguyen NV, Pham TD, Nguyen TC, Simmons C, Wills B, , 2010. Liver involvement associated with dengue infection in adults in Vietnam. Am J Trop Med Hyg 83: 774780.[Crossref]
  53. Laoprasopwattana K, Pruekprasert P, Dissaneewate P, Geater A, Vachvanichsanong P, , 2010. Outcome of dengue hemorrhagic fever-caused acute kidney injury in Thai children. J Pediatr 157: 303309.[Crossref]
  54. Seet RC, Lim EC, Wilder-Smith EP, , 2006. Acute transverse myelitis following dengue virus infection. J Clin Virol 35: 310312.[Crossref]
  55. Seet RC, Quek AM, Lim EC, , 2007. Symptoms and risk factors of ocular complications following dengue infection. J Clin Virol 38: 101105.[Crossref]
  56. Davis JS, Bourke P, , 2004. Rhabdomyolysis associated with dengue virus infection. Clin Infect Dis 38: E109E111.[Crossref]
  57. Lim M, Goh H, , 2005. Rhabfomyolysis following dengue virus infection. Singapore Med J 46: 645646.
  58. Hutspardol S, Prommalikit O, Upiya N, Chataroopwijit J, Khemakanok K, Assadamongkol K, , 2011. Heavy proteinuria following dengue hemorrhagic fever. Southeast Asian J Trop Med Public Health 42: 579582.
  59. Garcia G, Gonzalez N, Perez AB, Sierra B, Aguirre E, Rizo D, Izquierdo A, Sanchez L, Diaz D, Lezcay M, Pacheco B, Hirayama K, Guzman MG, , 2011. Long-term persistence of clinical symptoms in dengue-infected persons and its association with immunological disorders. Int J Infect Dis 15: E38E43.[Crossref]
  60. Gonzalez D, Martinez R, Castro O, Serrano T, Portela D, Vazquez S, Kouri G, Guzman MG, , 2005. Evaluation of some clinical, humoral, and immunological parameters in patients of dengue haemorrhagic fever six months after acute illness. Dengue Bull 29: 7984.
  61. Kularatne S, , 2005. Survey on the management of dengue infection in Sri Lanka: opinions of physicians and pediatricians. Southeast Asian J Trop Med Public Health 36: 11981200.
  62. Seet RC, Quek AM, Lim EC, , 2007. Post-infectious fatigue syndrome in dengue infection. J Clin Virol 38: 16.[Crossref]
  63. Teixeira LD, Lopes JS, Martins AG, Campos FA, Miranzi SD, Nascentes GA, , 2010. Persistence of dengue symptoms in patients in Uberaba, Minas Gerais State, Brazil. Cad Saude Publica 26: 625630.
  64. World Bank, 2011. GDP Per Capita (Current US$). Available at: http://data.worldbank.org/indicator/NY.GDP.PCAP.CD. Accessed October 17, 2011.
  65. Ministry of Health Malaysia, 2009. Health Expenditures Report (2007–2008). Malaysia National Health Accounts Project. Putrajaya, Malaysia: Malaysia National Health Accounts Unit, Planning and Development Division, Ministry of Health Malaysia.
  66. Department of Statistics Malaysia, The Source of Malaysia's Official Statistics. Available at: http://www.statistics.gov.my/portal/. Accessed January 2, 2011.
  67. 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.
  68. Halasa YA, Shepard DS, Zeng W, , 2012. Aggregate economic cost of dengue in Puerto Rico. Am J Trop Med Hyg 86: 745752.[Crossref]
  69. Kuo HI, Chang CL, Huang BW, Chen CC, McAleer M, , 2009. Estimating the impact of avian flu on international tourism demand using panel data. Tour Econ 15: 501511.[Crossref]

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  • Received : 09 Jan 2012
  • Accepted : 29 Jun 2012

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