title: Approaches to refining estimates of global burden and economics of dengue.
abstract: Dengue presents a formidable and growing global economic and disease burden, with around half the world's population estimated to be at risk of infection. There is wide variation and substantial uncertainty in current estimates of dengue disease burden and, consequently, on economic burden estimates. Dengue disease varies across time, geography and persons affected. Variations in the transmission of four different viruses and interactions among vector density and host's immune status, age, pre-existing medical conditions, all contribute to the disease's complexity. This systematic review aims to identify and examine estimates of dengue disease burden and costs, discuss major sources of uncertainty, and suggest next steps to improve estimates. Economic analysis of dengue is mainly concerned with costs of illness, particularly in estimating total episodes of symptomatic dengue. However, national dengue disease reporting systems show a great diversity in design and implementation, hindering accurate global estimates of dengue episodes and country comparisons. A combination of immediate, short-, and long-term strategies could substantially improve estimates of disease and, consequently, of economic burden of dengue. Suggestions for immediate implementation include refining analysis of currently available data to adjust reported episodes and expanding data collection in empirical studies, such as documenting the number of ambulatory visits before and after hospitalization and including breakdowns by age. Short-term recommendations include merging multiple data sources, such as cohort and surveillance data to evaluate the accuracy of reporting rates (by health sector, treatment, severity, etc.), and using covariates to extrapolate dengue incidence to locations with no or limited reporting. Long-term efforts aim at strengthening capacity to document dengue transmission using serological methods to systematically analyze and relate to epidemiologic data. As promising tools for diagnosis, vaccination, vector control, and treatment are being developed, these recommended steps should improve objective, systematic measures of dengue burden to strengthen health policy decisions.
authors.affiliation: Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, United States of America.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Shepard
authors.affiliation: Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, United States of America.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Undurraga
authors.affiliation: Carlos Slim Health Institute, Mexico City, Mexico.
authors.forename: Miguel
authors.initials: M
authors.lastname: Betancourt-Cravioto
authors.affiliation: Pedro Kourí Tropical Medicine Institute, Havana, Cuba.
authors.forename: María G
authors.initials: MG
authors.lastname: Guzmán
authors.affiliation: Dengue Vaccine Initiative, Rockville, Maryland, United States of America.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Halstead
authors.affiliation: University of California, Berkeley, California, United States of America.
authors.forename: Eva
authors.initials: E
authors.lastname: Harris
authors.affiliation: Ministry of Health, Putrajaya, Malaysia.
authors.forename: Rose Nani
authors.initials: RN
authors.lastname: Mudin
authors.affiliation: Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States of America.
authors.forename: Kristy O
authors.initials: KO
authors.lastname: Murray
authors.affiliation: Carlos Slim Health Institute, Mexico City, Mexico.
authors.forename: Roberto
authors.initials: R
authors.lastname: Tapia-Conyer
authors.affiliation: Duke-NUS Graduate Medical School, Singapore.
authors.forename: Duane J
authors.initials: DJ
authors.lastname: Gubler
mesh_terms: D017281:Cost of Illness; D003365:Costs and Cost Analysis / Q000379:methods; D003715:Dengue / Q000191:economics* / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy; D014943:Global Health; D017048:Health Care Costs; D006801:Humans