Estimating costs of care for meningitis infections in low- and middle-income countries.
Meningitis infections are often associated with high mortality and risk of sequelae. The costs of treatment and care for meningitis are a great burden on health care systems, particularly in resource-limited settings. The objective of this study is to review data on the costs of care for meningitis in low- and middle-income countries, as well as to show how results could be extrapolated to countries without sound data. We conducted a systematic review of the literature from six databases to identify studies examining the cost of care in low- and middle-income countries for all age groups with suspected, probable, or confirmed meningitis. We extracted data on treatment costs and sequelae by infectious agent and/or pathogen, where possible. Using multiple regression analysis, a relationship between hospital costs and associated determinants was investigated in order to predict costs in countries with missing data. This relationship was used to predict treatment costs for all 144 low- and middle-income countries. The methodology of conducting a systematic review, extrapolating, and setting up a standard database can be used as a tool to inform cost-effectiveness analyses in situations where cost of care data are poor. Both acute and long-term costs of meningitis could be extrapolated to countries without reliable data. Although only bacterial causes of meningitis can be vaccine-preventable, a better understanding of the treatment costs for meningitis is crucial for low- and middle-income countries to assess the cost-effectiveness of proposed interventions in their country. This cost information will be important as inputs in future cost-effectiveness studies, particularly for vaccines.
International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA. Electronic address: aportnoy@jhu.edu.
Allison
A
Portnoy
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Modelling and Economics Unit, Public Health England, London NW9 5EQ, United Kingdom. Electronic address: mark.jit@lshtm.ac.uk.
Mark
M
Jit
World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Electronic address: lauerj@who.int.
Jeremy
J
Lauer
Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, Campus Drie Eiken Lokaal D.R.212, 2610 Wilrijk, Antwerp, Belgium; Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Campus Diepenbeek Agoralaan Gebouw D; BE 3590, Diepenbeek, Belgium. Electronic address: adriaan.blommaert@uantwerpen.be.
Adriaan
A
Blommaert
International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA. Electronic address: ozawa@jhu.edu.
Sachiko
S
Ozawa
Independent Consultant, 2417 Panama Street, Philadelphia, PA 19103, USA. Electronic address: mlstack@outlook.com.
Meghan
M
Stack
International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA. Electronic address: jmurra35@jhu.edu.
Jillian
J
Murray
World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Electronic address: hutubessyr@who.int.
Raymond
R
Hutubessy
D003906:Developing Countries; D017048:Health Care Costs; D006801:Humans; D008581:Meningitis / Q000191:economics*; D015233:Models, Statistical
Costs; Hospital; Meningitis; Resource-limited settings