title: Calculation of the Average Cost per Case of Dengue Fever in Mexico Using a Micro-Costing Approach.
abstract: The increasing burden of dengue fever (DF) in the Americas, and the current epidemic in previously unaffected countries, generate major costs for national healthcare systems. There is a need to quantify the average cost per DF case. In Mexico, few data are available on costs, despite DF being endemic in some areas. Extrapolations from studies in other countries may prove unreliable and are complicated by the two main Mexican healthcare systems (the Secretariat of Health [SS] and the Mexican Social Security Institute [IMSS]). The present study aimed to generate specific average DF cost-per-case data for Mexico using a micro-costing approach.
  
  
  
  Expected medical costs associated with an ideal management protocol for DF (denoted ´ideal costs´) were compared with the medical costs of current treatment practice (denoted ´real costs´) in 2012. Real cost data were derived from chart review of DF cases and interviews with patients and key personnel from 64 selected hospitals and ambulatory care units in 16 states for IMSS and SS. In both institutions, ideal and real costs were estimated using the program, actions, activities, tasks, inputs (PAATI) approach, a micro-costing technique developed by us.
  
  
  
  Clinical pathways were obtained for 1,168 patients following review of 1,293 charts. Ideal and real costs for SS patients were US$165.72 and US$32.60, respectively, in the outpatient setting, and US$587.77 and US$490.93, respectively, in the hospital setting. For IMSS patients, ideal and real costs were US$337.50 and US$92.03, respectively, in the outpatient setting, and US$2,042.54 and US$1,644.69 in the hospital setting.
  
  
  
  The markedly higher ideal versus real costs may indicate deficiencies in the actual care of patients with DF. It may be necessary to derive better estimates with micro-costing techniques and compare the ideal protocol with current practice when calculating these costs, as patients do not always receive optimal care.
authors: Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
authors: Adriana
authors: A
authors: Zubieta-Zavala
authors: Center for Economic Studies and Social Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
authors: Guillermo
authors: G
authors: Salinas-Escudero
authors: Private practice, Mexico City, Mexico.
authors: Adrian
authors: A
authors: Ramírez-Chávez
authors: National Commission for Social Protection in Health, Mexico City, Mexico.
authors: Luis
authors: L
authors: García-Valladares
authors: Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
authors: Malaquias
authors: M
authors: López-Cervantes
authors: Medical Affairs, Sanofi Pasteur Latin America, Mexico City, Mexico.
authors: Juan Guillermo
authors: JG
authors: López Yescas
authors: Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
authors: Luis
authors: L
authors: Durán-Arenas
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data; D003695:Delivery of Health Care; D003715:Dengue / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008800:Mexico