title: The global economic burden of dengue: a systematic analysis.
abstract: Dengue is a serious global burden. Unreported and unrecognised apparent dengue virus infections make it difficult to estimate the true extent of dengue and current estimates of the incidence and costs of dengue have substantial uncertainty. Objective, systematic, comparable measures of dengue burden are needed to track health progress, assess the application and financing of emerging preventive and control strategies, and inform health policy. We estimated the global economic burden of dengue by country and super-region (groups of epidemiologically similar countries).
  
  
  
  We used the latest dengue incidence estimates from the Institute for Health Metrics and Evaluation's Global Burden of Disease Study 2013 and several other data sources to assess the economic burden of symptomatic dengue cases in the 141 countries and territories with active dengue transmission. From the scientific literature and regressions, we estimated cases and costs by setting, including the non-medical setting, for all countries and territories.
  
  
  
  Our global estimates suggest that in 2013 there were a total of 58·40 million symptomatic dengue virus infections (95% uncertainty interval [95% UI] 24 million-122 million), including 13 586 fatal cases (95% UI 4200-34 700), and that the total annual global cost of dengue illness was US$8·9 billion (95% UI 3·7 billion-19·7 billion). The global distribution of dengue cases is 18% admitted to hospital, 48% ambulatory, and 34% non-medical.
  
  
  
  The global cost of dengue is substantial and, if control strategies could reduce dengue appreciably, billions of dollars could be saved globally. In estimating dengue costs by country and setting, this study contributes to the needs of policy makers, donors, developers, and researchers for economic assessments of dengue interventions, particularly with the licensure of the first dengue vaccine and promising developments in other technologies.
  
  
  
  Sanofi Pasteur.
authors.affiliation: Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA. Electronic address: shepard@brandeis.edu.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Shepard
authors.affiliation: Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Undurraga
authors.affiliation: Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
authors.forename: Yara A
authors.initials: YA
authors.lastname: Halasa
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Stanaway
mesh_terms: D003140:Communicable Disease Control / Q000191:economics* / Q000379:methods; D017281:Cost of Illness; D003365:Costs and Cost Analysis / Q000379:methods / Q000706:statistics & numerical data*; D003715:Dengue / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control / Q000635:transmission; D000071219:Global Burden of Disease; D014943:Global Health; D006291:Health Policy; D006801:Humans; D015994:Incidence