title: Economic Impact of Dengue: Multicenter Study across Four Brazilian Regions.
abstract: BACKGROUND
  Dengue is an increasing public health concern in Brazil. There is a need for an updated evaluation of the economic impact of dengue within the country. We undertook this multicenter study to evaluate the economic burden of dengue in Brazil.
  
  
  METHODS
  We estimated the economic burden of dengue in Brazil for the years 2009 to 2013 and for the epidemic season of August 2012- September 2013. We conducted a multicenter cohort study across four endemic regions: Midwest, Goiania; Southeast, Belo Horizonte and Rio de Janeiro; Northeast: Teresina and Recife; and the North, Belem. Ambulatory or hospitalized cases with suspected or laboratory-confirmed dengue treated in both the private and public sectors were recruited. Interviews were scheduled for the convalescent period to ascertain characteristics of the dengue episode, date of first symptoms/signs and recovery, use of medical services, work/school absence, household spending (out-of-pocket expense) and income lost using a questionnaire developed for a previous cost study. We also extracted data from the patients' medical records for hospitalized cases. Overall costs per case and cumulative costs were calculated from the public payer and societal perspectives. National cost estimations took into account cases reported in the official notification system (SINAN) with adjustment for underreporting of cases. We applied a probabilistic sensitivity analysis using Monte Carlo simulations with 90% certainty levels (CL).
  
  
  RESULTS
  We screened 2,223 cases, of which 2,035 (91.5%) symptomatic dengue cases were included in our study. The estimated cost for dengue for the epidemic season (2012-2013) in the societal perspective was US$ 468 million (90% CL: 349-590) or US$ 1,212 million (90% CL: 904-1,526) after adjusting for under-reporting. Considering the time series of dengue (2009-2013) the estimated cost of dengue varied from US$ 371 million (2009) to US$ 1,228 million (2013).
  
  
  CONCLUSIONS
  The economic burden associated with dengue in Brazil is substantial with large variations in reported cases and consequently costs reflecting the dynamic of dengue transmission.
authors.affiliation: Department of Public Health, Aggeu Magalhaes Research Centre, Oswaldo Cruz Foundation, Recife, Brazil; Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiania, Brazil.
authors.forename: Celina Maria Turchi
authors.initials: CM
authors.lastname: Martelli
authors.affiliation: Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiania, Brazil.
authors.forename: Joao Bosco
authors.initials: JB
authors.lastname: Siqueira
authors.affiliation: Department of Community Health, Universidade Estadual do Piaui, Teresina, Brazil.
authors.forename: Mirian Perpetua Palha Dias
authors.initials: MP
authors.lastname: Parente
authors.affiliation: Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiania, Brazil.
authors.forename: Ana Laura de Sene Amancio
authors.initials: AL
authors.lastname: Zara
authors.affiliation: Universidade do Estado do Para, Belem, Brazil.
authors.forename: Consuelo Silva
authors.initials: CS
authors.lastname: Oliveira
authors.affiliation: Department of Public Health, Aggeu Magalhaes Research Centre, Oswaldo Cruz Foundation, Recife, Brazil.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Braga
authors.affiliation: Department of Health Surveillance, Secretaria Municipal Saude Belo Horizonte, Belo Horizonte, Brazil.
authors.forename: Fabiano Geraldo
authors.initials: FG
authors.lastname: Pimenta
authors.affiliation: Department of Health Science, Universidade de Pernambuco, Recife, Brazil.
authors.forename: Fanny
authors.initials: F
authors.lastname: Cortes
authors.affiliation: Health Economics and Market Access, Sanofi Pasteur Latin America, Mexico City, Mexico.
authors.forename: Juan Guillermo
authors.initials: JG
authors.lastname: Lopez
authors.affiliation: Department of Internal Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Luciana Ribeiro
authors.initials: LR
authors.lastname: Bahia
authors.affiliation: Department of Health Surveillance, Secretaria Municipal Saude Belo Horizonte, Belo Horizonte, Brazil.
authors.forename: Marcia Costa Ooteman
authors.initials: MC
authors.lastname: Mendes
authors.affiliation: Department of Internal Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Michelle Quarti Machado
authors.initials: MQ
authors.lastname: da Rosa
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Noemia Teixeira
authors.initials: NT
authors.lastname: de Siqueira Filha
authors.affiliation: Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Dagna
authors.initials: D
authors.lastname: Constenla
authors.affiliation: Department of Public Health, Aggeu Magalhaes Research Centre, Oswaldo Cruz Foundation, Recife, Brazil.
authors.forename: Wayner Vieira
authors.initials: WV
authors.lastname: de Souza
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003715:Dengue / Q000191:economics* / Q000453:epidemiology; D005260:Female; D005102:Health Expenditures; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult