Cost and disease burden of dengue in Cambodia.
BACKGROUND
Dengue is endemic in Cambodia (pop. estimates 14.4 million), a country with poor health and economic indicators. Disease burden estimates help decision makers in setting priorities. Using recent estimates of dengue incidence in Cambodia, we estimated the cost of dengue and its burden using disability adjusted life years (DALYs).


METHODS
Recent population-based cohort data were used to calculate direct and productive costs, and DALYs. Health seeking behaviors were taken into account in cost estimates. Specific age group incidence estimates were used in DALYs calculation.


RESULTS
The mean cost per dengue case varied from US$36 - $75 over 2006-2008 respectively, resulting in an overall annual cost from US$3,327,284 in 2008 to US$14,429,513 during a large epidemic in 2007. Patients sustain the highest share of costs by paying an average of 78% of total costs and 63% of direct medical costs. DALY rates per 100,000 individuals ranged from 24.3 to 100.6 in 2007-2008 with 80% on average due to premature mortality.


CONCLUSIONS
Our analysis confirmed the high societal and individual family burden of dengue. Total costs represented between 0.03 and 0.17% of Gross Domestic Product. Health seeking behavior has a major impact on costs. The more accurate estimate used in this study will better allow decision makers to account for dengue costs particularly among the poor when balancing the benefits of introducing a potentially effective dengue vaccine.
Beauté
Julien
J
Epidemiology and Public Health Unit, Institut Pasteur in Cambodia, Bd Monivong 5, BP 983 Phnom Penh, Cambodia. julbeaute@yahoo.fr
Vong
Sirenda
S
D002160:Cambodia / Q000453:epidemiology; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003715:Dengue / Q000191:economics* / Q000453:epidemiology / Q000503:physiopathology; D006291:Health Policy; D006801:Humans; D019057:Quality-Adjusted Life Years
Vaccine. 2004 Mar 12;22(9-10):1275-80
15003657
Bull World Health Organ. 1994;72(3):429-45
8062401
BMJ. 2000 May 13;320(7245):1335
10807635
Appl Health Econ Health Policy. 2006;5(3):137-53
17132029
Trop Med Int Health. 2004 Feb;9(2):273-80
15040566
Am J Trop Med Hyg. 2009 May;80(5):846-55
19407136
Trop Med Int Health. 2009 Feb;14(2):237-46
19171013
PLoS Negl Trop Dis. 2010 Nov 30;4(11):e903
21152061
Trans R Soc Trop Med Hyg. 2008 Jun;102(6):570-7
18402995
Am J Trop Med Hyg. 2003 Feb;68(2):191-202
12641411
Am J Trop Med Hyg. 2005 Jun;72(6):786-91
15964964
BMC Public Health. 2009 May 27;9:155
19473500
Health Econ. 1999 Feb;8(1):1-8
10082139
Am J Trop Med Hyg. 1998 Aug;59(2):265-71
9715944
BMC Public Health. 2007 Sep 24;7:262
17892564
Int J Equity Health. 2008 Apr 25;7:10
18439268
Lancet. 2007 Apr 28;369(9571):1452-1459
17467515
Health Policy. 2006 Jun;77(1):51-63
16139925
Soc Sci Med. 2004 Feb;58(3):553-64
14652051
Health Policy Plan. 1997 Dec;12(4):273-85
10176263
Pharmacoeconomics. 2009;27(5):379-89
19586076
Bull World Health Organ. 2010 Sep 1;88(9):650-7
20865069
Health Policy Plan. 2001 Sep;16(3):326-31
11527874
Trop Med Int Health. 2007 Sep;12(9):1026-36
17875014