Quality of life among adults with confirmed dengue in Brazil.

The main objective of this study was to measure the quality of life (QoL) during a dengue episode. We conducted a facility-based survey in central Brazil in 2005 and recruited 372 laboratory-confirmed dengue patients greater than 12 years of age in hospital and ambulatory settings. We administered the World Health Organization QoL instrument approximately 15 days after the onset of symptoms. We used principal component analysis with varimax rotation to identify domains related to QoL. The median age of interviewees was 36 years. Most (85%) reported their general health status as very good or good before the dengue episode. Although ambulatory patients were mainly classified as having dengue fever, 44.8% of hospitalized patients had dengue hemorrhagic fever or intermediate dengue. Principal component analysis identified five principal components related to cognition, sleep and energy, mobility, self-care, pain, and discomfort, which explained 73% of the variability of the data matrix. Hospitalized patients had significantly lower mean scores for dimensions cognition, self-care, and pain than ambulatory patients. This investigation documented the generally poor QoL during a dengue episode caused by the large number of domains affected and significant differences between health care settings.

Cost of dengue cases in eight countries in the Americas and Asia: a prospective study.

Despite the growing worldwide burden of dengue fever, the global economic impact of dengue illness is poorly documented. Using a common protocol, we present the first multicountry estimates of the direct and indirect costs of dengue cases in eight American and Asian countries. We conducted prospective studies of the cost of dengue in five countries in the Americas (Brazil, El Salvador, Guatemala, Panama, and Venezuela) and three countries in Asia (Cambodia, Malaysia, and Thailand). All studies followed the same core protocol with interviews and medical record reviews. The study populations were patients treated in ambulatory and hospital settings with a clinical diagnosis of dengue. Most studies were performed in 2005. Costs are in 2005 international dollars (I$). We studied 1,695 patients (48% pediatric and 52% adult); none died. The average illness lasted 11.9 days for ambulatory patients and 11.0 days for hospitalized patients. Among hospitalized patients, students lost 5.6 days of school, whereas those working lost 9.9 work days per average dengue episode. Overall mean costs were I$514 and I$1,394 for an ambulatory and hospitalized case, respectively. With an annual average of 574,000 cases reported, the aggregate annual economic cost of dengue for the eight study countries is at least I$587 million. Preliminary adjustment for under-reporting could raise this total to $1.8 billion, and incorporating costs of dengue surveillance and vector control would raise the amount further. Dengue imposes substantial costs on both the health sector and the overall economy.

Clinical characteristics and national economic cost of the 2005 dengue epidemic in Panama.

In 2005, Panama experienced the largest dengue epidemic since 1993. We conducted both a prospective clinical and a national economic study. The full cost analysis measured costs of dengue cases and of dengue control efforts in the entire country. Costs are in 2005 US$. Ambulatory patients were 130 of the 136 participants, with 82% adults (18+) and 62% women. Duration of fever and illness averaged 6.1 (standard deviation [SD], 5.3) and 21.2 (SD 13.5) days, respectively. Loss in quality of life averaged 67% (SD 21) during the worst days of illness. An average ambulatory and hospitalized case cost $332 and $1,065, respectively. Although 5,489 cases were officially reported, the Ministry of Health (MOH) estimated 32,900 actual cases, implying a total cost of $11.8 million. Additionally, estimated government spending on dengue control efforts was $5 million. This dengue epidemic had a major disease impact and an economic cost of $16.9 million ($5.22 per capita).