RESUMO
The health profile of Bangladesh has improved remarkably, yet gaps in delivering quality health care remain. In response to the need for evidence to quantify resources for providing health services in Bangladesh, this study estimates unit costs of providing the essential services package (ESP) in the not-for-profit sector. This study used a stratified sampling approach to select 18 static clinics, which had fixed facilities, from 330 non-profit clinics under Smiling Sun network in Bangladesh. Costs were estimated from the providers' perspective, using both top-down and bottom-up methods, from July 2014 to June 2015. In total, there were 1115 observations (clients) for the 13 primary care services analysed. The estimated 2015 average costs per visit were: antenatal care ($7.03), postnatal care ($4.57), control of diarrheal diseases ($1.32), acute respiratory infection ($1.53), integrated management of child illness ($2.02), sexually transmitted infections ($4.70), reproductive tract infections ($3.56), tuberculosis ($41.65), limited curative care ($4.30), immunization ($2.23), family planning ($0.72), births by normal delivery ($29.45) and C-section ($114.83). Unit costs varied widely for each service, both between individual patients and among clinic level means. The coefficient of variation for the 13 services averaged 66%, implying potential inefficiencies. In addition, 32.9% of clients were not offered any lab test during the first antenatal visit. The unit cost of essential services differed by the type and location of clinics. Ultra clinics, on average, incurred 37% higher costs than vital (outpatient type) clinics, and urban clinics spent 40% more than rural clinics to deliver a unit of service. The study suggests that inefficiency and quality concerns exist in health service delivery in some facilities. Increasing the volume of clients through demand-side mechanisms and standardization of services would help address those concerns. Unit costs of services provide essential information for estimating resource needs for scaling up the ESPs.
Assuntos
Atenção à Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Organizações/economia , Bangladesh , Humanos , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Atenção Primária à Saúde/economiaAssuntos
Saúde Global , Doenças Negligenciadas/epidemiologia , Medicina Tropical , Infecções Bacterianas/economia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/mortalidade , Controle de Doenças Transmissíveis , Efeitos Psicossociais da Doença , Humanos , Incidência , Doenças Negligenciadas/economia , Doenças Negligenciadas/mortalidade , Doenças Parasitárias/economia , Doenças Parasitárias/epidemiologia , Doenças Parasitárias/mortalidade , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Viroses/economia , Viroses/epidemiologia , Viroses/mortalidadeRESUMO
BACKGROUND: 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). METHODS: 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. FINDINGS: 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 13â586 fatal cases (95% UI 4200-34â700), 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. INTERPRETATION: 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. FUNDING: Sanofi Pasteur.
Assuntos
Controle de Doenças Transmissíveis/economia , Custos e Análise de Custo/estatística & dados numéricos , Dengue/economia , Dengue/epidemiologia , Carga Global da Doença , Controle de Doenças Transmissíveis/métodos , Efeitos Psicossociais da Doença , Custos e Análise de Custo/métodos , Dengue/mortalidade , Dengue/prevenção & controle , Dengue/transmissão , Saúde Global , Política de Saúde , Humanos , IncidênciaRESUMO
BACKGROUND: Dengue is the most common arbovirus infection globally, but its burden is poorly quantified. We estimated dengue mortality, incidence, and burden for the Global Burden of Disease Study 2013. METHODS: We modelled mortality from vital registration, verbal autopsy, and surveillance data using the Cause of Death Ensemble Modelling tool. We modelled incidence from officially reported cases, and adjusted our raw estimates for under-reporting based on published estimates of expansion factors. In total, we had 1780 country-years of mortality data from 130 countries, 1636 country-years of dengue case reports from 76 countries, and expansion factor estimates for 14 countries. FINDINGS: We estimated an average of 9221 dengue deaths per year between 1990 and 2013, increasing from a low of 8277 (95% uncertainty estimate 5353-10 649) in 1992, to a peak of 11â302 (6790-13â722) in 2010. This yielded a total of 576â900 (330â000-701â200) years of life lost to premature mortality attributable to dengue in 2013. The incidence of dengue increased greatly between 1990 and 2013, with the number of cases more than doubling every decade, from 8·3 million (3·3 million-17·2 million) apparent cases in 1990, to 58·4 million (23·6 million-121·9 million) apparent cases in 2013. When accounting for disability from moderate and severe acute dengue, and post-dengue chronic fatigue, 566â000 (186â000-1â415â000) years lived with disability were attributable to dengue in 2013. Considering fatal and non-fatal outcomes together, dengue was responsible for 1·14 million (0·73 million-1·98 million) disability-adjusted life-years in 2013. INTERPRETATION: Although lower than other estimates, our results offer more evidence that the true symptomatic incidence of dengue probably falls within the commonly cited range of 50 million to 100 million cases per year. Our mortality estimates are lower than those presented elsewhere and should be considered in light of the totality of evidence suggesting that dengue mortality might, in fact, be substantially higher. FUNDING: Bill & Melinda Gates Foundation.
Assuntos
Dengue/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Carga Global da Doença/estatística & dados numéricos , Anos de Vida Ajustados por Qualidade de Vida , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dengue/mortalidade , Feminino , Saúde Global , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores SexuaisRESUMO
Dengue fever, an arbovirus disease transmitted by Aedes mosquitoes, has recently spread rapidly, especially in the tropical countries of the Americas and Asia-Pacific regions. It is endemic in Malaysia, with an annual average of 37,937 reported dengue cases from 2007 to 2012. This study measured the overall economic impact of dengue in Malaysia, and estimated the costs of dengue prevention. In 2010, Malaysia spent US$73.5 million or 0.03% of the country's GDP on its National Dengue Vector Control Program. This spending represented US$1,591 per reported dengue case and US$2.68 per capita population. Most (92.2%) of this spending occurred in districts, primarily for fogging. A previous paper estimated the annual cost of dengue illness in the country at US$102.2 million. Thus, the inclusion of preventive activities increases the substantial estimated cost of dengue to US$175.7 million, or 72% above illness costs alone. If innovative technologies for dengue vector control prove efficacious, and a dengue vaccine was introduced, substantial existing spending could be rechanneled to fund them.
Assuntos
Aedes/virologia , Dengue/prevenção & controle , Doenças Endêmicas , Insetos Vetores/virologia , Controle de Mosquitos/economia , Animais , Efeitos Psicossociais da Doença , Dengue/economia , Dengue/epidemiologia , Vacinas contra Dengue/economia , Doenças Endêmicas/economia , Doenças Endêmicas/prevenção & controle , Humanos , Malásia/epidemiologiaRESUMO
We examined variations in dengue vector control costs and resource consumption between the District Health Departments (DHDs) and Local Authorities (LAs) to assist informed decision making as to the future roles of these agencies in the delivery of dengue vector control services in Malaysia. Data were collected from the vector control units of DHDs and LAs in 8 selected districts. We captured costs and resource consumption in 2010 for premise inspection for mosquito breeding sites, fogging to destroy adult mosquitoes and larviciding of potential breeding sites. Overall, DHDs spent US$5.62 million or US$679 per case and LAs spent US$2.61 million or US$499 per case. The highest expenditure for both agencies was for fogging, 51.0% and 45.8% of costs for DHDs and LAs, respectively. The DHDs had higher resource costs for human personnel, vehicles, pesticides, and equipment. The findings provide some evidence to rationalize delivery of dengue vector control services in Malaysia.
Assuntos
Dengue/prevenção & controle , Controle de Mosquitos/economia , Animais , Custos e Análise de Custo , Humanos , Insetos Vetores , MalásiaRESUMO
Dengue, the world's most important mosquito-borne viral disease, is endemic in the Philippines. During 2008-2012, the country's Department of Health reported an annual average of 117,065 dengue cases, placing the country fourth in dengue burden in southeast Asia. This study estimates the country's annual number of dengue episodes and their economic cost. Our comparison of cases between active and passive surveillance in Punta Princesa, Cebu City yielded an expansion factor of 7.2, close to the predicted value (7.0) based on the country's health system. We estimated an annual average of 842,867 clinically diagnosed dengue cases, with direct medical costs (in 2012 US dollars) of $345 million ($3.26 per capita). This is 54% higher than an earlier estimate without Philippines-specific costs. Ambulatory settings treated 35% of cases (representing 10% of direct costs), whereas inpatient hospitals served 65% of cases (representing 90% of direct costs). The economic burden of dengue in the Philippines is substantial.
Assuntos
Efeitos Psicossociais da Doença , Dengue/economia , Dengue/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Filipinas/epidemiologia , Vigilância da População , Anos de Vida Ajustados por Qualidade de VidaRESUMO
Aedes albopictus is the most invasive mosquito in the world, an important disease vector, and a biting nuisance that limits outdoor activities. Area-wide integrated pest management (AW-IPM) is the recommended control strategy. We conducted an economic evaluation of the AW-IPM project in Mercer and Monmouth Counties, New Jersey with a controlled design (AW-IPM vs. control) from 2009 through 2011. The study analyzed financial documents and staff time for AW-IPM and surveyed an average of 415 randomly chosen households in AW-IPM and control areas each fall from 2008 through 2011. Hours lost from yard and porch activities were calculated as differences between actual and potential hours of these activities in an average summer week if there had been no mosquito concerns. Net estimated benefits of AW-IPM were based on cross-over and difference-in-difference analyses. Reductions in hours lost were valued based on respondents' willingness to pay for a hypothetical extra hour free of mosquitoes spent on yard or porch activities and literature on valuation of a quality adjusted life year (QALY). The incremental cost of AW-IPM per adult was $41.18 per year. Number of hours lost due to mosquitoes in AW-IPM areas between the base year (2008) and the intervention years (2009-2011) declined by 3.30 hours per summer week in AW-IPM areas compared to control areas. Survey respondents valued this improvement at $27.37 per adult per summer week. Over the 13-week summer, an average adult resident gained 42.96 hours of yard and porch time, worth $355.82. The net benefit over the summer was $314.63. With an average of 0.0027 QALYs gained per adult per year, AW-IPM was cost effective at $15,300 per QALY gained. The benefit-cost ratio from hours gained was 8.64, indicating that each $1 spent on AW-IPM gave adults additional porch and yard time worth over $8.
Assuntos
Aedes , Controle de Mosquitos/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Análise Custo-Benefício , Características da Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Jersey , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
Between 2006 and 2012 India reported an annual average of 20,474 dengue cases. Although dengue has been notifiable since 1996, regional comparisons suggest that reported numbers substantially underrepresent the full impact of the disease. Adjustment for underreporting from a case study in Madurai district and an expert Delphi panel yielded an annual average of 5,778,406 clinically diagnosed dengue cases between 2006 and 2012, or 282 times the reported number per year. The total direct annual medical cost was US$548 million. Ambulatory settings treated 67% of cases representing 18% of costs, whereas 33% of cases were hospitalized, comprising 82% of costs. Eighty percent of expenditures went to private facilities. Including non-medical and indirect costs based on other dengue-endemic countries raises the economic cost to $1.11 billion, or $0.88 per capita. The economic and disease burden of dengue in India is substantially more than captured by officially reported cases, and increased control measures merit serious consideration.
Assuntos
Efeitos Psicossociais da Doença , Dengue/epidemiologia , Dengue/economia , Humanos , Índia/epidemiologiaRESUMO
The recent expansion of Aedes albopictus, a day-biting mosquito, to densely inhabited areas in the northeastern Atlantic states of the USA has dramatically increased the problem that mosquitoes create for urban and suburban residents. We quantified the impact of mosquitoes on residents' quality of life within the context of a comprehensive area-wide integrated pest management program to control Ae. albopictus in two counties (Mercer and Monmouth) in New Jersey. We interviewed residents of 121 randomly selected households in both counties between October and November 2010. We asked residents about their experience with mosquitoes in their neighborhood and the importance of the ability to relax outdoors without mosquitoes compared to other neighborhood characteristics (1â=ânot important, 5â=âextremely important). We rated residents' utility based on paired comparisons to known states from the EuroQol health description system. The majority (54.6%) of respondents considered mosquitoes to be a problem. Respondents reported an average of 7.1 mosquito bites in a typical week during that summer. Mosquitoes prevented 59.5% of residents from enjoying their outdoor activities at least to some extent. Residents rated the mosquito acceptability (mean ± standard deviation) during that summer on a scale of 0 (mosquito invasion) to 100 (no mosquitoes) at 56.7±28.7, and their overall utility at 0.87±0.03. This is comparable to living with up to two risk factors for diabetes (i.e., abdominal obesity, body mass index of 28 or more, reported cholesterol problems, diagnosis of hypertension, or history of cardiovascular disease) or women experiencing menstrual disorders. Respondents rated the importance of enjoying outdoor activities without mosquitoes (4.69±0.80) comparable to that of neighborhood safety (4.74±0.80) and higher than that of a clean neighborhood (4.59±0.94). In conclusion, New Jersey residents reported that mosquitoes decreased their utility by 0.13, comparable to the loss from worrisome health risk factors, underscoring the importance of controlling this problem.
Assuntos
Culicidae/fisiologia , Entrevistas como Assunto/métodos , Qualidade de Vida , Recreação/fisiologia , Adulto , Aedes/fisiologia , Idoso , Animais , Características da Família , Feminino , Humanos , Insetos Vetores/fisiologia , Masculino , Pessoa de Meia-Idade , Controle de Mosquitos/métodos , Controle de Mosquitos/estatística & dados numéricos , New Jersey , Características de Residência , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Dengue poses a substantial economic and disease burden in Southeast Asia (SEA). Quantifying this burden is critical to set policy priorities and disease-control strategies. METHODS AND FINDINGS: We estimated the economic and disease burden of dengue in 12 countries in SEA: Bhutan, Brunei, Cambodia, East-Timor, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Viet Nam. We obtained reported cases from multiple sources--surveillance data, World Health Organization (WHO), and published studies--and adjusted for underreporting using expansion factors from previous literature. We obtained unit costs per episode through a systematic literature review, and completed missing data using linear regressions. We excluded costs such as prevention and vector control, and long-term sequelae of dengue. Over the decade of 2001-2010, we obtained an annual average of 2.9 million (m) dengue episodes and 5,906 deaths. The annual economic burden (with 95% certainty levels) was US$950m (US$610m-US$1,384m) or about US$1.65 (US$1.06-US$2.41) per capita. The annual number of disability-adjusted life years (DALYs), based on the original 1994 definition, was 214,000 (120,000-299,000), which is equivalent to 372 (210-520) DALYs per million inhabitants. CONCLUSION: Dengue poses a substantial economic and disease burden in SEA with a DALY burden per million inhabitants in the region. This burden is higher than that of 17 other conditions, including Japanese encephalitis, upper respiratory infections, and hepatitis B.
Assuntos
Efeitos Psicossociais da Doença , Dengue/economia , Dengue/epidemiologia , Sudeste Asiático/epidemiologia , Dengue/mortalidade , Custos de Cuidados de Saúde , Humanos , Análise de SobrevidaRESUMO
BACKGROUND: Dengue virus infection is the most common arthropod-borne disease of humans and its geographical range and infection rates are increasing. Health policy decisions require information about the disease burden, but surveillance systems usually underreport the total number of cases. These may be estimated by multiplying reported cases by an expansion factor (EF). METHODS AND FINDINGS: As a key step to estimate the economic and disease burden of dengue in Southeast Asia (SEA), we projected dengue cases from 2001 through 2010 using EFs. We conducted a systematic literature review (1995-2011) and identified 11 published articles reporting original, empirically derived EFs or the necessary data, and 11 additional relevant studies. To estimate EFs for total cases in countries where no empirical studies were available, we extrapolated data based on the statistically significant inverse relationship between an index of a country's health system quality and its observed reporting rate. We compiled an average 386,000 dengue episodes reported annually to surveillance systems in the region, and projected about 2.92 million dengue episodes. We conducted a probabilistic sensitivity analysis, simultaneously varying the most important parameters in 20,000 Monte Carlo simulations, and derived 95% certainty level of 2.73-3.38 million dengue episodes. We estimated an overall EF in SEA of 7.6 (95% certainty level: 7.0-8.8) dengue cases for every case reported, with an EF range of 3.8 for Malaysia to 19.0 in East Timor. CONCLUSION: Studies that make no adjustment for underreporting would seriously understate the burden and cost of dengue in SEA and elsewhere. As the sites of the empirical studies we identified were not randomly chosen, the exact extent of underreporting remains uncertain. Nevertheless, the results reported here, based on a systematic analysis of the available literature, show general consistency and provide a reasonable empirical basis to adjust for underreporting.
Assuntos
Efeitos Psicossociais da Doença , Dengue/epidemiologia , Sudeste Asiático/epidemiologia , Dengue/tratamento farmacológico , Notificação de Doenças/estatística & dados numéricos , HumanosRESUMO
Dengue, endemic in Puerto Rico, reached a record high in 2010. To inform policy makers, we derived annual economic cost. We assessed direct and indirect costs of hospitalized and ambulatory dengue illness in 2010 dollars through surveillance data and interviews with 100 laboratory-confirmed dengue patients treated in 2008-2010. We corrected for underreporting by using setting-specific expansion factors. Work absenteeism because of a dengue episode exceeded the absenteeism for an episode of influenza or acute otitis media. From 2002 to 2010, the aggregate annual cost of dengue illness averaged $38.7 million, of which 70% was for adults (age 15+ years). Hospitalized patients accounted for 63% of the cost of dengue illness, and fatal cases represented an additional 17%. Households funded 48% of dengue illness cost, the government funded 24%, insurance funded 22%, and employers funded 7%. Including dengue surveillance and vector control activities, the overall annual cost of dengue was $46.45 million ($12.47 per capita).
Assuntos
Efeitos Psicossociais da Doença , Dengue/economia , Dengue/epidemiologia , Hospitalização/economia , Adulto , Instituições de Assistência Ambulatorial/economia , Criança , Custos e Análise de Custo , Humanos , Porto Rico/epidemiologiaRESUMO
Using contingent valuation we estimated the perceived value of an area-wide integrated pest management program for the Asian tiger mosquito, Aedes albopictus, implemented in Monmouth and Mercer counties, NJ. We estimated residents' maximum willingness-to-pay and perceived monetary benefits (willingness-to-pay excluding residents who protested all types of payments) and payment modality through a telephone survey of 51 randomly selected households. The mean (+/- SE) perceived monetary benefits for an enhanced mosquito abatement program was $9.54 +/- 2.90 per capita per year. Most respondents would have been willing to pay through taxes (35%) or charitable donations (6%) starting then, or through one of these approaches in the future (43%), whereas 16% were completely unwilling to pay any additional costs whatsoever. We projected that the perceived monetary benefits to the counties' 1.01 million residents for an enhanced mosquito control program would be $9.61 million annually. Thus, collectively residents perceived monetary benefits of 3.67 times the combined 2008 annual operating costs of the counties' existing mosquito control programs of $2.61 million.
Assuntos
Aedes/fisiologia , Inseticidas/farmacologia , Controle de Mosquitos/economia , Controle de Mosquitos/métodos , Controle Biológico de Vetores/economia , Controle Biológico de Vetores/métodos , Adulto , Idoso , Animais , Coleta de Dados , Características da Família , Feminino , Humanos , Inseticidas/economia , Masculino , Pessoa de Meia-IdadeRESUMO
The growing burden of dengue in endemic countries and outbreaks in previously unaffected countries stress the need to assess the economic impact of this disease. This paper synthesizes existing studies to calculate the economic burden of dengue illness in the Americas from a societal perspective. Major data sources include national case reporting data from 2000 to 2007, prospective cost of illness studies, and analyses quantifying underreporting in national routine surveillance systems. Dengue illness in the Americas was estimated to cost $2.1 billion per year on average (in 2010 US dollars), with a range of $1-4 billion in sensitivity analyses and substantial year to year variation. The results highlight the substantial economic burden from dengue in the Americas. The burden for dengue exceeds that from other viral illnesses, such as human papillomavirus (HPV) or rotavirus. Because this study does not include some components (e.g., vector control), it may still underestimate total economic consequences of dengue.