Researchers estimate worldwide economic burden of dengue

In 2013, the global economic burden of 58.4 million symptomatic dengue virus infections in the 141 countries and territories with active transmission was $8.89 billion, researchers estimated in a study published in The Lancet Infectious Diseases.

Most of the economic burden is estimated to be in two super-regions, or groups of countries that are epidemiologically similar, according to the researchers: Latin America and the Caribbean, and Southeast Asia, East Asia and Oceania.

“The global cost of dengue is substantial,” Donald S. Shepard, PhD, professor at the Schneider Institutes for Health Policy at Brandeis University, and colleagues wrote. “If control strategies could reduce dengue appreciably, billions of dollars could be saved globally each year. With the availability of new and promising technologies to control dengue, policymakers and donors need reliable economic data to assist in their decision to adopt these new approaches.”

A previous study conducted by Shepard and other colleagues was used to obtain the number of cases of dengue. The economic cost of each case of dengue was derived from published studies of dengue costs, an expert survey and national economic data, Shepard and colleagues wrote. They used countries with existing empirical estimates about dengue as models for countries without such data, looking at patterns in the estimates to predict values for the remaining countries.

According to the researchers’ estimates, the total weighted average cost of all types of dengue cases in 2013 was $151. This included 10.5 million dengue patients who were treated in a hospital at an average cost of $70.10 per case; 28.1 million patients who were treated in an ambulatory health care setting at an average cost of $51.16; 19.7 million patients who were not treated professionally because of factors such as limited access to care, but still cost an average of $12.94 per case; and 13,586 fatal cases of dengue at an average estimated cost of $84,730.

Costs per case of dengue ranged from $56 in sub-Saharan Africa to $1,146 in a high-income super-region that included the United States, Argentina, Australia, Brunei and Singapore. The global cost of dengue was $1.56 per capita in the 141 countries where dengue is endemic.

Study was 'well-timed'

In a related editorial, Mark Jit, PhD, MPH, of the department of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine, said the study by Shepard and colleagues about the economic cost of dengue, was “well-timed.”

Jit said the methods used in the study, including plugging gaps where data was unavailable, are not beyond criticism, although he called them “arguably unavoidable.” The results “allow comparisons between countries and regions to be properly drawn for the first time,” Jit wrote.

“Particularly, the study highlights the cost of dengue in Africa and south Asia where dengue transmission is ongoing but cases are substantially underreported because of low awareness and poor surveillance,” he said. “These data shortcomings might have contributed to underinvestment in developing dengue control measures that are appropriate for those settings.

“Of course such comparisons need to be caveated since the estimates in Africa and south Asia are informed by the least local data. Shepard and colleagues' estimates will not eliminate the need for local data collection, particularly in areas where data are still lacking. However, they provide impetus to consider the case for dengue prevention in every endemic region in the world.”

Previous study shows dramatic increase in dengue cases

In a parallel study published earlier this year, Shepard and other colleagues estimated the number of dengue cases by country and super-region and found that the incidence of dengue increased dramatically between 1990 and 2013, from 8.3 million to 58.4 million.

Their estimates on the global human toll of dengue also included:

an average of 9,221 deaths per year attributable to dengue between 1990 and 2013;
576,900 total years of life lost to premature death from dengue in 2013; and
566,000 total years lived with disability attributable to dengue in 2013.

Shepard and colleagues said their estimates were lower than others, but offered more evidence that the incidence of symptomatic dengue “probably falls within the commonly cited range of 50 million to 100 million cases per year.” – by Gerard Gallagher

References:

Jit M. Lancet Infect Dis. 2016:doi:10.1016/S1473-3099(16)30001-9.

Shepard DS, et al. Lancet Infect Dis. 2016;doi:10.1016/S1473-3099(16)00146-8.

Stanaway JD, et al. Lancet Infect Dis. 2016;doi:10.1016/S1473-3099(16)00026-8.

Disclosure: The researchers report no relevant financial disclosures. Jit reports being on a WHO dengue working group with Shepard.