title: The Economic Burden Attributable to a Child's Inpatient Admission for Diarrheal Disease in Rwanda.
abstract: BACKGROUND
  Diarrhea is one of the leading causes of childhood morbidity and mortality. Hospitalization for diarrhea can pose a significant burden to health systems and households. The objective of this study was to estimate the economic burden attributable to hospitalization for diarrhea among children less than five years old in Rwanda. These data can be used by decision-makers to assess the impact of interventions that reduce diarrhea morbidity, including rotavirus vaccine introduction.
  
  
  METHODS
  This was a prospective costing study where medical records and hospital bills for children admitted with diarrhea at three hospitals were collected to estimate resource use and costs. Hospital length of stay was calculated from medical records. Costs incurred during the hospitalization were abstracted from the hospital bills. Interviews with the child's caregivers provided data to estimate household costs which included transport costs and lost income. The portion of medical costs borne by insurance and household were reported separately. Annual economic burden before and after rotavirus vaccine introduction was estimated by multiplying the reported number of diarrhea hospitalizations in public health centers and district hospitals by the estimated economic burden per hospitalization. All costs are presented in 2014 US$.
  
  
  RESULTS
  Costs for 203 children were analyzed. Approximately 93% of the children had health insurance coverage. Average hospital length of stay was 5.3 ± 3.9 days. Average medical costs for each child for the illness resulting in a hospitalization were $44.22 ± $23.74 and the total economic burden was $101, of which 65% was borne by the household. For households in the lowest income quintile, the household costs were 110% of their monthly income. The annual economic burden to Rwanda attributable to diarrhea hospitalizations ranged from $1.3 million to $1.7 million before rotavirus vaccine introduction.
  
  
  CONCLUSIONS
  Households often bear the largest share of the economic burden attributable to diarrhea hospitalization and the burden can be substantial, especially for households in the lowest income quintile.
authors.affiliation: Université Libre de Bruxelles, Ecole de Santé Publique, Brussels, Belgium.|Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Fidele
authors.initials: F
authors.lastname: Ngabo
authors.affiliation: PATH, Devices and Tools Global Program, Seattle 98121, Washington, United States of America.
authors.forename: Mercy
authors.initials: M
authors.lastname: Mvundura
authors.affiliation: PATH, Vaccine Access and Delivery Global Program, Seattle 98121, Washington, United States of America.
authors.forename: Lauren
authors.initials: L
authors.lastname: Gazley
authors.affiliation: Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Maurice
authors.initials: M
authors.lastname: Gatera
authors.affiliation: World Health Organization, Rwanda Country Office, Kigali, Rwanda.
authors.forename: Celse
authors.initials: C
authors.lastname: Rugambwa
authors.affiliation: Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Eugene
authors.initials: E
authors.lastname: Kayonga
authors.affiliation: Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Tuyishime
authors.affiliation: Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Niyibaho
authors.affiliation: World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Mwenda
authors.affiliation: Université Libre de Bruxelles, Ecole de Santé Publique, Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Donnen
authors.affiliation: Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lepage
authors.affiliation: Ministry of Health, Kigali, Rwanda.|Harvard Medical School, Boston, Massachusetts, United States of America.|Geisel School of Medicine, Dartmouth, Hanover, New Hampshire, United States of America.
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
authors.affiliation: PATH, Vaccine Access and Delivery Global Program, Seattle 98121, Washington, United States of America.
authors.forename: Deborah
authors.initials: D
authors.lastname: Atherly
mesh_terms: D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D003967:Diarrhea / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000191:economics; D008297:Male; D010343:Patient Admission / Q000191:economics*; D011446:Prospective Studies; D012400:Rotavirus Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D022243:Rotavirus Vaccines / Q000008:administration & dosage / Q000191:economics*; D012432:Rwanda
chemical_list: D022243:Rotavirus Vaccines