A multi-country study of the economic burden of dengue fever based on patient-specific field surveys in Burkina Faso, Kenya, and Cambodia

PLoS Neglected Tropical Diseases
(Accessed 2 Mar 2019)

Research Article
A multi-country study of the economic burden of dengue fever based on patient-specific field surveys in Burkina Faso, Kenya, and Cambodia
Jung-Seok Lee , Vittal Mogasale , Jacqueline K. Lim , Sowath Ly , Kang Sung Lee , Sopheak Sorn , Esther Andia , Mabel Carabali , Suk Namkung , Sl-Ki Lim , Valéry Ridde , Sammy M. Njenga , Seydou Yaro , In-Kyu Yoon
Dengue fever is a rapidly growing public health problem in many parts of the tropics and sub-tropics in the world. While there are existing studies on the economic burden of dengue fever in some of dengue-endemic countries, cost components are often not standardized, making cross-country comparisons challenging. Furthermore, no such studies have been available in Africa.
Methods/Principal findings
A patient-specific survey questionnaire was developed and applied in Burkina Faso, Kenya, and Cambodia in a standardized format. Multiple interviews were carried out in order to capture the entire cost incurred during the period of dengue illness. Both private (patient’s out-of-pocket) and public (non-private) expenditure were accessed to understand how the economic burden of dengue is distributed between private and non-private payers.
A substantial number of dengue-confirmed patients were identified in all three countries: 414 in Burkina Faso, 149 in Kenya, and 254 in Cambodia. The average cost of illness for dengue fever was $26 (95% CI $23-$29) and $134 (95% CI $119-$152) per inpatient in Burkina Faso and Cambodia, respectively. In the case of outpatients, the average economic burden per episode was $13 (95% CI $23-$29) in Burkina Faso and $23 (95% CI $19-$28) in Kenya. Compared to Cambodia, public contributions were trivial in Burkina Faso and Kenya, reflecting that a majority of medical costs had to be directly borne by patients in the two countries.
The cost of illness for dengue fever is significant in the three countries. In particular, the current study sheds light on the potential economic burden of the disease in Burkina Faso and Kenya where existing evidence is sparse in the context of dengue fever, and underscores the need to achieve Universal Health Coverage. Given the availability of the current (CYD-TDV) and second-generation dengue vaccines in the near future, our study outcomes can be used to guide decision makers in setting health policy priorities.

Author summary
Dengue fever is a major public health concern in many parts of South-East Asia and South America. In addition to countries where dengue has been highly prevalent for many years, there is a growing concern on the undocumented burden of dengue in Africa. Following the successful execution of the first-round economic burden study in Vietnam, Thailand, and Colombia by the Dengue Vaccine Initiative, the second-round economic burden study was implemented in Burkina Faso, Kenya and Cambodia using the same standardized methodology. In particular, the second-round study targeted GAVI eligible countries for future vaccine introductions and included two African countries where the burden of dengue was relatively unknown. Our study outcomes show that the economic burden of dengue fever is significant in all three countries. The dengue vaccination era began in 2016 with the first dengue vaccine (CYD-TDV) although its public use should be carefully determined due to the safety concerns related to the vaccine. Considering that there are other second-generation dengue vaccines in development, the current study outcomes provide an important step to estimate the economic benefits of vaccination in the three countries.