title: Direct costs of dengue hospitalization in Brazil: public and private health care systems and use of WHO guidelines.
abstract: BACKGROUND
  Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed.
  
  
  RESULTS
  To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20).
  
  
  CONCLUSIONS
  The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care.
authors.affiliation: Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil.
authors.forename: Alessandra A
authors.initials: AA
authors.lastname: Vieira Machado
authors.affiliation: Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil.
authors.forename: Anderson Oliveira
authors.initials: AO
authors.lastname: Estevan
authors.affiliation: Faculty of Math, State University of Mato Grosso do Sul, Nova Andradina, Mato Grosso do Sul, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sales
authors.affiliation: Faculty of Engineering, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil.
authors.forename: Kelly Cristina da Silva
authors.initials: KC
authors.lastname: Brabes
authors.affiliation: Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil.
authors.forename: Júlio
authors.initials: J
authors.lastname: Croda
authors.affiliation: Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil.
authors.forename: Fábio Juliano
authors.initials: FJ
authors.lastname: Negrão
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics*; D003715:Dengue / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D004196:Disease Outbreaks / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011634:Public Health / Q000191:economics*; D012189:Retrospective Studies