title: Economic and disease burden of dengue in Mexico.
abstract: BACKGROUND
  Dengue imposes a substantial economic and disease burden in most tropical and subtropical countries. Dengue incidence and severity have dramatically increased in Mexico during the past decades. Having objective and comparable estimates of the economic burden of dengue is essential to inform health policy, increase disease awareness, and assess the impact of dengue prevention and control technologies.
  
  
  RESULTS
  We estimated the annual economic and disease burden of dengue in Mexico for the years 2010-2011. We merged multiple data sources, including a prospective cohort study; patient interviews and macro-costing from major hospitals; surveillance, budget, and health data from the Ministry of Health; WHO cost estimates; and available literature. We conducted a probabilistic sensitivity analysis using Monte Carlo simulations to derive 95% certainty levels (CL) for our estimates. Results suggest that Mexico had about 139,000 (95%CL: 128,000-253,000) symptomatic and 119 (95%CL: 75-171) fatal dengue episodes annually on average (2010-2011), compared to an average of 30,941 symptomatic and 59 fatal dengue episodes reported. The annual cost, including surveillance and vector control, was US$170 (95%CL: 151-292) million, or $1.56 (95%CL: 1.38-2.68) per capita, comparable to other countries in the region. Of this, $87 (95%CL: 87-209) million or $0.80 per capita (95%CL: 0.62-1.12) corresponds to illness. Annual disease burden averaged 65 (95%CL: 36-99) disability-adjusted life years (DALYs) per million population. Inclusion of long-term sequelae, co-morbidities, impact on tourism, and health system disruption during outbreaks would further increase estimated economic and disease burden.
  
  
  CONCLUSIONS
  With this study, Mexico joins Panama, Puerto Rico, Nicaragua, and Thailand as the only countries or areas worldwide with comprehensive (illness and preventive) empirical estimates of dengue burden. Burden varies annually; during an outbreak, dengue burden may be significantly higher than that of the pre-vaccine level of rotavirus diarrhea. In sum, Mexico's potential economic benefits from dengue control would be substantial.
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: Instituto Nacional de Salud Pública, Cuernavaca, Mexico; Center for Tropical Diseases, University of Texas-Medical Branch, Galveston, Texas, United States of America.
authors.forename: José
authors.initials: J
authors.lastname: Ramos-Castañeda
authors.affiliation: Instituto Nacional de Salud Pública, Cuernavaca, Mexico; Organización Latinoamericana para el Fomento de la Investigación en Salud, Bucaramanga, Colombia.
authors.forename: Ruth
authors.initials: R
authors.lastname: Martínez-Vega
authors.affiliation: Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Méndez-Galván
authors.affiliation: Duke-NUS Graduate Medical School, Singapore.
authors.forename: Duane J
authors.initials: DJ
authors.lastname: Gubler
authors.affiliation: Pedro Kourí Tropical Medicine Institute, Havana, Cuba.
authors.forename: María G
authors.initials: MG
authors.lastname: Guzmán
authors.affiliation: Pediatric 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, Berkeley, California, United States of America.
authors.forename: Eva
authors.initials: E
authors.lastname: Harris
authors.affiliation: Ministry of Health, Mexico City, Mexico.
authors.forename: Pablo
authors.initials: P
authors.lastname: Kuri-Morales
authors.affiliation: Carlos Slim Health Institute, Mexico City, Mexico.
authors.forename: Roberto
authors.initials: R
authors.lastname: Tapia-Conyer
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
mesh_terms: D000328:Adult; D002017:Budgets; D015331:Cohort Studies; D017281:Cost of Illness; D003715:Dengue / Q000191:economics* / Q000453:epidemiology*; D006291:Health Policy / Q000191:economics*; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008297:Male; D008800:Mexico; D009527:Nicaragua; D010176:Panama; D011446:Prospective Studies; D011647:Puerto Rico; D019057:Quality-Adjusted Life Years; D013785:Thailand