Household and Hospitalization Costs of Pediatric Dengue Illness in Colombo, Sri Lanka

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  • 1 Health Office Egodauyana, Ministry of Health, Colombo, Sri Lanka;
  • 2 Department of Political Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates;
  • 3 Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka;
  • 4 Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany;
  • 5 Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom;
  • 6 Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden;
  • 7 Department of Economics, University of Colombo, Colombo, Sri Lanka;
  • 8 School of Global Public Health, New York University, New York, New York

Dengue, a mosquito-borne viral infection that affects millions around the world, poses a substantial economic burden in endemic countries. We conducted a prospective costing study in hospitalized pediatric dengue patients at the Lady Ridgeway Hospital for Children (LRHC), a public pediatric hospital in Colombo district, Sri Lanka, to assess household out-of-pocket and hospitalization costs of dengue in pediatric patients during peak dengue transmission season. Between August and October 2013, we recruited 216 hospitalized patients (aged 0–3 years, 27%; 4–7 years, 29%; 8–12 years, 42%) who were clinically or laboratory diagnosed with dengue. Using 2013 US dollars, household out-of-pocket spending, on average, was US$59 (SD 49) per episode and increased with disease severity (DF, US$52; DHF/DSS, US$78). Pediatric dengue patients received free-of-charge medical care during hospitalization at LRHC, and this places a high financial burden on hospitals. The direct medical cost of hospitalization was US$68.0 (SD 31.4) for DF episode, and US$122.7 (SD 65.2) for DHF/DSS episode. Yet a hospitalized dengue illness episode still accounted for 20% to 35% of household monthly income due to direct and indirect costs. Additionally, a majority of caregivers (70%) sought outpatient care before hospitalization, most of whom (81%) visited private health facilities. Our findings indicate that hospitalized pediatric dengue illness poses a nontrivial cost burden to households and healthcare systems, emphasizing the importance of preventing and controlling the transmission of dengue in endemic countries.

Author Notes

Address correspondence to Yesim Tozan, New York University School of Global Public Health, 14 East 4th Street, 3rd floor, New York, NY 10003. E-mail: tozan@nyu.edu

Authors’ addresses: Enoka Sonali Fernando, Health Office Egodauyana, Ministry of Health, Colombo, Sri Lanka, E-mail: enokasonalifernando@yahoo.com. Tyler Y. Headley, Department of Political Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates, E-mail: tyh255@nyu.edu. Hasitha Tissera, Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka, E-mail: dr_korelege@yahoo.co.uk. Annelies Wilder-Smith, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany, Department of Disease Control, London School of Hygiene and Tropical Medicine, Department of Public Health and Clinical Medicine, London, United Kingdom, and Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden, E-mail: wilder-smith@uni-heidelberg.de. Amala De Silva, Department of Economics, University of Colombo, Colombo, Sri Lanka, E-mail: amala@econ.cmb.ac.lk. Yesim Tozan, School of Global Public Health, New York University, New York, NY, E-mail: tozan@nyu.edu.

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