Economic Impact of Dengue: Multicenter Study across Four Brazilian Regions

PLoS Negl Trop Dis. 2015 Sep 24;9(9):e0004042. doi: 10.1371/journal.pntd.0004042. eCollection 2015.

Abstract

Background: Dengue is an increasing public health concern in Brazil. There is a need for an updated evaluation of the economic impact of dengue within the country. We undertook this multicenter study to evaluate the economic burden of dengue in Brazil.

Methods: We estimated the economic burden of dengue in Brazil for the years 2009 to 2013 and for the epidemic season of August 2012- September 2013. We conducted a multicenter cohort study across four endemic regions: Midwest, Goiania; Southeast, Belo Horizonte and Rio de Janeiro; Northeast: Teresina and Recife; and the North, Belem. Ambulatory or hospitalized cases with suspected or laboratory-confirmed dengue treated in both the private and public sectors were recruited. Interviews were scheduled for the convalescent period to ascertain characteristics of the dengue episode, date of first symptoms/signs and recovery, use of medical services, work/school absence, household spending (out-of-pocket expense) and income lost using a questionnaire developed for a previous cost study. We also extracted data from the patients' medical records for hospitalized cases. Overall costs per case and cumulative costs were calculated from the public payer and societal perspectives. National cost estimations took into account cases reported in the official notification system (SINAN) with adjustment for underreporting of cases. We applied a probabilistic sensitivity analysis using Monte Carlo simulations with 90% certainty levels (CL).

Results: We screened 2,223 cases, of which 2,035 (91.5%) symptomatic dengue cases were included in our study. The estimated cost for dengue for the epidemic season (2012-2013) in the societal perspective was US$ 468 million (90% CL: 349-590) or US$ 1,212 million (90% CL: 904-1,526) after adjusting for under-reporting. Considering the time series of dengue (2009-2013) the estimated cost of dengue varied from US$ 371 million (2009) to US$ 1,228 million (2013).

Conclusions: The economic burden associated with dengue in Brazil is substantial with large variations in reported cases and consequently costs reflecting the dynamic of dengue transmission.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brazil / epidemiology
  • Child
  • Child, Preschool
  • Cost of Illness*
  • Dengue / economics*
  • Dengue / epidemiology
  • Female
  • Health Expenditures
  • Health Services / statistics & numerical data
  • Humans
  • Infant
  • Interviews as Topic
  • Male
  • Middle Aged
  • Prospective Studies
  • Young Adult

Grants and funding

Funding for this Study was provided by Sanofi Pasteur. CMTM and WVdS received fellowship grants (CNPq# 306489/2010-4, #305947/20060). CMTM, WVdS, CB, and JBSB are research members of the National Institute of Science and Technology for Health Technology Assessment (IATS). ALdSAZ, FC and NTdSF received scholarships from CNPq/IATS. CMTM, ALdSAZ, MPPDP, FC, NTdSF, FGJP, MCOM, LRB, MQMdR, CSO, CB, and JBSJ received funds to their institutes from Sanofi Pasteur to support their work in the Multicenter Cost Study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.