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Dengue Cost of Illness Studies: Status Report Presented at: Spring Meeting of Board of Counselors  Donald S. Shepard, Ph.D.* Jose Suaya, M.D., Ph.D.* Mariana Caram, M.A.* Site colleagues *Program Management Team, Dengue Burden Studies

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Dengue cost of illness studies status report l.jpg
Dengue Cost of Illness Studies: Status Report

Presented at:

Spring Meeting of Board of Counselors

 Donald S. Shepard, Ph.D.*

Jose Suaya, M.D., Ph.D.*

Mariana Caram, M.A.*

Site colleagues

*Program Management Team, Dengue Burden Studies

Schneider Institute for Health Policy, Heller School, MS 035

Brandeis University, Waltham, MA 02454-9110 USA

Tel: 781-736-3975 • Fax: 781-736-3928


E-mail: [email protected]

April 25-26, 2006, Seoul, Korea


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Site Colleagues

  • Prof. Lucy Lum Chai See, MD

  • Malaysia

  • Dr. Sukhontha Kongsin, PhD

  • Thailand


Overview l.jpg

  • Objectives, Background

  • Methods

  • Preliminary Results

  • Conclusions and Next Steps


Objectives l.jpg

  • Examine economic burden of dengue on households, governments, and private sector (employers, insurers).

  • Build capacity for health services and policy research on dengue by involving policy makers and practitioners from many countries.


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2001 – Ho Chi Minh City, Vietnam stakeholder dengue meeting included economic topics.

2002 – Burden of Illness (BOI) included in PDVI’s grant application to Gates Foundation and countries invited to submit concept papers.

2003 – PDVI issued a Request for Proposals for the BOI Program Management Team (PMT) and selected Brandeis University

2004 – PMT recommended and PDVI approved and funded studies in 8 countries.

2005 – Data collection started.

2006 – Data are being cleaned and analyzed. Reports of results and international workshops are being planned.


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  • Cost of illness: Economic cost imposed by a disease due to prevention, treatment, and lost economic output (major focus of work to date). Key elements:

    • Cost to health sector and lost economic output

    • Costs of treatment and prevention (vector control)

    • Treatment costs calculated per case and aggregate to the country

    • Age breakdown of treatment costs: children and adults

  • Burden of illness: Loss of good health, generally measured in DALYs, due to morbidity and mortality imposed by the disease (minor focus of work to date).

  • 6

    Overview7 l.jpg

    • Objectives

    • Methods

    • Preliminary Results

    • Conclusions and Next Steps


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    Methods and Data

    • Conceptual frameworks: National Health Accounts (NHA) and Cost of Illness (COI).

    • Data collection and analysis

    • Collaborating institutions (research and patient care), subjects, and labs.


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    Frameworks: NHA

    • Describes the spending on health for a country or region.

    • Uses a consistent set of definitions limited to the organized health sector to compare data across countries

    • Organizes results in a matrix structure that classifies financing agent (e.g. government or out-of-pocket) against type of care.


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    Disease-Specific NHA

    • Uses

      • Shows relative importance of that disease.

      • Informs about treatment choices and settings.

      • Informs about prevention choices including the development of new approaches (e.g. vaccine).

    • Challenge: data needs

      • Consistent definitions

      • Cost per treatment episode or per year by stage or type

      • Incidence (acute conditions or complications) or prevalence (chronic conditions), often by stage or type

      • Current and potential prevention options, costs, and effectiveness


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    Frameworks: COI

    • Describes the overall economic cost of a disease of a country or region.

    • Determines direct and indirect costs.

      • Direct costs are economic costs within the health sector for prevention and treatment.

      • Indirect costs are economic costs of lost time, lost quality of life, and lost wages associated with the disease.

    • Based on welfare economics: collateral treatment expenses; economic losses.


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    Data collection

    • Subjects (or caretakers) interviewed once or twice about illness, treatment, and caretaker visits.

    • Medical records abstracted.

    • Lab data collected from records or tests during the study.

    • Information entered into customized Microsoft Access database.

    • Data converted into SPSS, cleaned, aggregated by subject.


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    Data analysis

    • Key formula:

      Total cost of a resource = Quantity x Unit cost

    • Quantity and unit cost can be obtained from separate data sources.

    • Example 1: Hospital costs

      Hospitalization cost = length of stay x cost per day

    • Example 2: Lost time from self-employment or household activities

      Cost of lost time = days lost x value per day


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    Number of Participants(as of 4/20/06)


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    Asked at midterm review: What is status of serology testing?

    Studies were designed to follow current laboratory test practices at study sites, so our samples and costs are representative of the current laboratory capacity in the countries studied.

    Tests were performed at national or regional reference laboratories.

    Depending on the timing and number of blood samples, laboratories performed serology tests, viral isolation, and/or PCR.

    Fraction of patients receiving serology tests varied with care patterns in the countries.

    In six countries, all patients tested.

    In three countries, about half tested.

    Serology: Gates Foundation Question


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    • Objectives

    • Methods

    • Preliminary Results

    • Conclusions and Next Steps


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    Cost per hospitalized case, US$*

    * Data collected by Prof. Lucy Lum from 654 dengue hospitalizations in 2 public and 2 private hospitals around Kuala Lumpur in 2003.


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    Preliminary estimate of national cost

    • Needs national estimate of cost per case (assumed data from Malaysia were representative)

    • Needs national number of cases (derived for hospital cases from expansion factor)


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    Expansion Factor:Relation to Notification Rate


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    Aggregate NHA cost of dengue cases in Malaysia for hospitalization (US$ million)


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    NHA: Overall cost of dengue in Malaysia hospitalization (US$ million)

    • Preliminary total $12.79 million

    • Excludes ambulatory-only cases (not yet analyzed)

    • Equivalent to 940,000 workdays of output


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    Derivation of indirect costs hospitalization (US$ million)


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    COI in Malaysia: other costs hospitalization (US$ million)


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    Quantities of key activities, Thailand hospitalization (US$ million)


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    Estimated cost per hospitalized case hospitalization (US$ million)


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    Overview hospitalization (US$ million)

    • Objectives

    • Methods

    • Preliminary Results

    • Conclusions and Next Steps


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    Country conclusions hospitalization (US$ million)

    • The cost of dengue treatment per hospitalized case in Malaysia ($718) is equivalent to 53 days of lost output.

    • These treatment costs are financed by government (70%), employers and insurers (13%), and households (17%).

    • Development and adoption of a dengue vaccine would offset 87% of treatment costs for all of Southeast Asia and may permit reductions in spending on vector control.

    • The National Health Accounts analysis shows the value of investing in a dengue vaccine to multiple stakeholders.


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    Project status conclusions hospitalization (US$ million)

    • As most investigators were new to health services research, we are proud of their work.

    • Data should allow a good estimate of dengue cost per case at each site.

    • Burden of Illness Studies are possible to conduct in several countries.

    • Existing data should support estimates of population-based costs in two countries (Brazil and Malaysia).

    • Numerous extensions under discussion with PDVI to strengthen population-based studies of treatment and costs of vector control.