PLoS Neglected Tropical Diseases
February 2013
http://www.plosntds.org/article/browseIssue.action

Research Article
Economic and Disease Burden of Dengue in Southeast Asia
Donald S. Shepard, Eduardo A. Undurraga, Yara A. Halasa
http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0002055;jsessionid=C2F39798C5198E1BE55C007C82AEE356

Abstract
Background
Dengue poses a substantial economic and disease burden in Southeast Asia (SEA). Quantifying this burden is critical to set policy priorities and disease-control strategies.

Methods and Findings
We estimated the economic and disease burden of dengue in 12 countries in SEA: Bhutan, Brunei, Cambodia, East-Timor, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Viet Nam. We obtained reported cases from multiple sources—surveillance data, World Health Organization (WHO), and published studies—and adjusted for underreporting using expansion factors from previous literature. We obtained unit costs per episode through a systematic literature review, and completed missing data using linear regressions. We excluded costs such as prevention and vector control, and long-term sequelae of dengue. Over the decade of 2001–2010, we obtained an annual average of 2.9 million (m) dengue episodes and 5,906 deaths. The annual economic burden (with 95% certainty levels) was US$950m (US$610m–US$1,384m) or about US$1.65 (US$1.06–US$2.41) per capita. The annual number of disability-adjusted life years (DALYs), based on the original 1994 definition, was 214,000 (120,000–299,000), which is equivalent to 372 (210–520) DALYs per million inhabitants.

Conclusion
Dengue poses a substantial economic and disease burden in SEA with a DALY burden per million inhabitants in the region. This burden is higher than that of 17 other conditions, including Japanese encephalitis, upper respiratory infections, and hepatitis B.

Author Summary
Dengue fever, or break bone fever, is the most common infectious disease transmitted by a mosquito, and is a major economic and disease burden in endemic countries. Between 100–200 million (m) infections occur each year in more than 100 countries, resulting in about 20,000 deaths. Quantifying the burden of dengue is critical for policy makers to set policy priorities and make informed decisions about disease control. We estimated the economic and disease burden of dengue in 12 countries in Southeast Asia, using a consistent methodology that allows comparison among countries. We estimated an annual average of 2.9 m dengue episodes and 5,906 deaths. This amounts to an annual cost per capita of US$1.65 (0.03% GDP per capita in 2010), and a disease burden of 372 disability-adjusted life years (DALYs) per million inhabitants, a rate higher than that of 17 other conditions, including Japanese encephalitis, upper respiratory infections, and hepatitis B.

Use of Expansion Factors to Estimate the Burden of Dengue in Southeast Asia: A Systematic Analysis
Eduardo A. Undurraga, Yara A. Halasa, Donald S. Shepard
PLOS Neglected Tropical Diseases: published 21 Feb 2013 | info:doi/10.1371/journal.pntd.0002056