The macroeconomic impact of a dengue outbreak: Case studies from Thailand and Brazil.

BACKGROUND: Dengue is spreading in (sub)tropical areas, and half of the global population is at risk. The macroeconomic impact of dengue extends beyond healthcare costs. This study evaluated the impact of dengue on gross domestic product (GDP) based on approaches tailored to two dengue-endemic countries, Thailand and Brazil, from the tourism and workforce perspectives, respectively. FINDINGS: Because the tourism industry is a critical economic sector for Thailand, lost tourism revenues were estimated to analyze the impact of a dengue outbreak. An input-output model estimated that the direct effects (on international tourism) and indirect effects (on suppliers) of dengue on tourism reduced overall GDP by 1.43 billion US dollars (USD) (0.26%) in the outbreak year 2019. The induced effect (reduced employee income/spending) reduced Thailand's GDP by 375 million USD (0.07%). Overall, lost tourism revenues reduced Thailand's GDP by an estimated 1.81 billion USD (0.33%) in 2019 (3% of annual tourism revenue). An inoperability input-output model was used to analyze the effect of workforce absenteeism on GDP due to a dengue outbreak in Brazil. This model calculates the number of lost workdays associated with ambulatory and hospitalized dengue. Input was collected from state-level epidemiological and economic data for 2019. An estimated 22.4 million workdays were lost in the employed population; 39% associated with the informal sector. Lost workdays due to dengue reduced Brazil's GDP by 876 million USD (0.05%). CONCLUSIONS: The economic costs of dengue outbreaks far surpass the direct medical costs. Dengue reduces overall GDP and inflicts national economic losses. With a high proportion of the population lacking formal employment in both countries and low income being a barrier to seeking care, dengue also poses an equity challenge. A combination of public health measures, like vector control and vaccination, against dengue is recommended to mitigate the broader economic impact of dengue.

Cost of controlling the dengue vector Aedes aegypti in the Peruvian amazon. / Costo del control de Aedes aegypti en la Amazonía peruana.

OBJECTIVE.: Motivation for the study. Dengue prevention and control is based on the control of its vector. This study was conducted because of the need to know the costs associated with Aedes aegypti control in a region that carries out planned vector control activities. Main findings. The costs incurred in dengue vector control in the Loreto region in 2017 and 2018 amounted to PEN 4,066,380.25 and PEN 3,807,858.73, respectively. Implications. Knowing the cost of vector control activities will allow us to better plan these activities and have a basis for cost-effectiveness studies with other methods of prevention and control of dengue. To estimate the costs incurred in the control of Aedes aegypti in the Loreto region, during the years 2017 and 2018. MATERIALS AND METHODS.: We conducted a partial retrospective economic evaluation of the costs of Aedes aegypti control of the Regional Health Directorate Loreto, during the implementation of the Regional Plan for Surveillance and Control of Aedes aegypti. Documentation such as plans, intervention reports and payment slips were reviewed, and interviews were conducted with professional personnel involved in vector control, on the costs of control interventions. RESULTS.: We found that the costs incurred in dengue vector control in the Loreto Region in the two years were: PEN 3,807,858 and PEN 4,066,380 during 2017 and 2018, respectively (USD 1,175,264 and USD 1,1210,232 at the 2017 and 2018 exchange rate). However, the effect of control activities is short-lived. CONCLUSIONS.: The high cost involved in vector control with the methods currently used and the short duration of its effect make it unsustainable. Studies should be conducted in order to find other more efficient methods for dengue control.

OBJETIVO.: Motivación para realizar el estudio. La prevención y control del dengue se basa en el control de su vector. Este estudio se realizó por la necesidad de conocer los costos asociados al control Aedes aegypti en una región que realiza actividades planificadas de control vectorial. Principales hallazgos. Los costos incurridos en el control del vector del dengue en la región Loreto en los años 2017 y 2018, ascienden a 4,066,380.25 y 3,807,858.73 PEN, respectivamente. Implicancias. Conocer el costo de las actividades de control vectorial nos permitirá planificar mejor estas actividades y tener una base para estudios de costo efectividad con otros métodos de prevención y control del dengue. Estimar los costos incurridos en el control del Aedes aegypti en la región Loreto, en los años 2017 y 2018. MATERIALES Y MÉTODOS.: Se realizó una evaluación económica retrospectiva parcial de los costos del control del Aedes aegypti de la Dirección Regional de Salud Loreto, durante la ejecución del Plan Regional de Vigilancia y Control de Aedes aegypti. Se revisó documentación como planes, informes de intervenciones y planillas de pago y se realizaron entrevistas al personal profesional implicado en el control vectorial, sobre los costos de las intervenciones de control. RESULTADOS.: Se halló, que los costos incurridos en el control del vector del dengue en la Región Loreto en los dos años estudiados ascienden a: 3,807,858 PEN y 4,066,380 PEN durante el 2017 y 2018, respectivamente (1´175,264 USD y 1´1210,232 USD al tipo de cambio del 2017 y 2018). Sin embargo, el efecto de las actividades de control es de corta duración. CONCLUSIONES.: El alto costo que implica el control vectorial con los métodos usados actualmente y la corta duración de su efecto lo hace insostenible. Se deben realizar estudios para hallar otros métodos más eficientes para el control del dengue.

Prevention and control of dengue and chikungunya in Colombia: A cost-effectiveness analysis.

BACKGROUND: Chikungunya and dengue are emerging diseases that have caused large outbreaks in various regions of the world. Both are both spread by Aedes aegypti and Aedes albopictus mosquitos. We developed a dynamic transmission model of chikungunya and dengue, calibrated to data from Colombia (June 2014 -December 2017). METHODOLOGY/PRINCIPAL FINDINGS: We evaluated the health benefits and cost-effectiveness of residual insecticide treatment, long-lasting insecticide-treated nets, routine dengue vaccination for children aged 9, catchup vaccination for individuals aged 10-19 or 10-29, and portfolios of these interventions. Model calibration resulted in 300 realistic transmission parameters sets that produced close matches to disease-specific incidence and deaths. Insecticide was the preferred intervention and was cost-effective. Insecticide averted an estimated 95 chikungunya cases and 114 dengue cases per 100,000 people, 61 deaths, and 4,523 disability-adjusted life years (DALYs). In sensitivity analysis, strategies that included dengue vaccination were cost-effective only when the vaccine cost was 14% of the current price. CONCLUSIONS/SIGNIFICANCE: Insecticide to prevent chikungunya and dengue in Colombia could generate significant health benefits and be cost-effective. Because of limits on diagnostic accuracy and vaccine efficacy, the cost of dengue testing and vaccination must decrease dramatically for such vaccination to be cost-effective in Colombia. The vectors for chikungunya and dengue have recently spread to new regions, highlighting the importance of understanding the effectiveness and cost-effectiveness of policies aimed at preventing these diseases.

Temperature, traveling, slums, and housing drive dengue transmission in a non-endemic metropolis.

Dengue is steadily increasing worldwide and expanding into higher latitudes. Current non-endemic areas are prone to become endemic soon. To improve understanding of dengue transmission in these settings, we assessed the spatiotemporal dynamics of the hitherto largest outbreak in the non-endemic metropolis of Buenos Aires, Argentina, based on detailed information on the 5,104 georeferenced cases registered during summer-autumn of 2016. The highly seasonal dengue transmission in Buenos Aires was modulated by temperature and triggered by imported cases coming from regions with ongoing outbreaks. However, local transmission was made possible and consolidated heterogeneously in the city due to housing and socioeconomic characteristics of the population, with 32.8% of autochthonous cases occurring in slums, which held only 6.4% of the city population. A hierarchical spatiotemporal model accounting for imperfect detection of cases showed that, outside slums, less-affluent neighborhoods of houses (vs. apartments) favored transmission. Global and local spatiotemporal point-pattern analyses demonstrated that most transmission occurred at or close to home. Additionally, based on these results, a point-pattern analysis was assessed for early identification of transmission foci during the outbreak while accounting for population spatial distribution. Altogether, our results reveal how social, physical, and biological processes shape dengue transmission in Buenos Aires and, likely, other non-endemic cities, and suggest multiple opportunities for control interventions.

Climatic and socio-economic factors supporting the co-circulation of dengue, Zika and chikungunya in three different ecosystems in Colombia.

Dengue, Zika and chikungunya are diseases of global health significance caused by arboviruses and transmitted by the mosquito Aedes aegypti, which is of worldwide circulation. The arrival of the Zika and chikungunya viruses to South America increased the complexity of transmission and morbidity caused by these viruses co-circulating in the same vector mosquito species. Here we present an integrated analysis of the reported arbovirus cases between 2007 and 2017 and local climate and socio-economic profiles of three distinct Colombian municipalities (Bello, Cúcuta and Moniquirá). These locations were confirmed as three different ecosystems given their contrasted geographic, climatic and socio-economic profiles. Correlational analyses were conducted with both generalised linear models and generalised additive models for the geographical data. Average temperature, minimum temperature and wind speed were strongly correlated with disease incidence. The transmission of Zika during the 2016 epidemic appeared to decrease circulation of dengue in Cúcuta, an area of sustained high incidence of dengue. Socio-economic factors such as barriers to health and childhood services, inadequate sanitation and poor water supply suggested an unfavourable impact on the transmission of dengue, Zika and chikungunya in all three ecosystems. Socio-demographic influencers were also discussed including the influx of people to Cúcuta, fleeing political and economic instability from neighbouring Venezuela. Aedes aegypti is expanding its range and increasing the global threat of these diseases. It is therefore vital that we learn from the epidemiology of these arboviruses and translate it into an actionable local knowledge base. This is even more acute given the recent historical high of dengue cases in the Americas in 2019, preceding the COVID-19 pandemic, which is itself hampering mosquito control efforts.

Cost-effectiveness analysis of VECTOS software for the control of diseases transmitted by Aedes aegypti in two Colombian municipalities / [Análisis de costo-efectividad del uso del programa VECTOS en el control rutinario de enfermedades transmitidas por Aedes aegypti en dos municipios de Santander, Colombia].

Introduction: Diseases transmitted by Aedes aegypti are considered a public health problem. VECTOS is a novel software for the integration of vector control strategies. Objective: To assess the cost-effectiveness of the use of VECTOS in the routine control programs of diseases transmitted by A. aegypti in the municipality of San Juan de Girón (Santander). Materials and methods: We conducted a cost-effectiveness analysis using a decision analysis model from the perspective of the local health authorities. We considered the use of the VECTOS software in the routine control activities in the municipality of San Juan de Girón during 2016 as the treatment group while the routine control in the municipality of Floridablanca, where VECTOS is not implemented, was considered as the comparator. We calculated the incremental cost-effectiveness ratio (ICER) taking as effectiveness measure the disability-adjusted life years (DALY). Results: VECTOS was cost-effective at a rate of USD$ 660,4 savings per each DALY avoided compared to the routine control in Floridablanca. The probabilistic model showed that the system was cost-effective in 70% of the 10.000 iterations for a threshold between 1 to 3 GDP per capita. Conclusions: VECTOS software as implemented in the municipality of San Juan de Girón is highly cost-effective and could be used in other municipalities in the country where diseases transmitted by A. aegypti are endemic.

Introducción. Las enfermedades transmitidas por Aedes aegypti son un problema de salud pública. VECTOS es un programa novedoso de integración de estrategias de control de vectores. Objetivo. Evaluar el costo-efectividad del uso del VECTOS en los programas de control rutinario de enfermedades transmitidas por el vector Aedes aegypti en el municipio de San Juan de Girón (Santander). Materiales y métodos. Se evaluó el costo-efectividad del programa empleando un modelo de análisis de decisiones desde la perspectiva de las autoridades locales de salud. Se estudió la integración de las estrategias de control de vectores mediante el programa VECTOS utilizado en el municipio de San Juan de Girón durante el 2016, con el control rutinario llevado a cabo sin VECTOS en el municipio de Floridablanca. Se calculó la razón incremental del costo-efectividad (RICE), usando como medida de efectividad los años de vida ajustados por discapacidad (AVAD). Resultados. El uso del programa VECTOS fue rentable a una tasa de ahorro de USD$660,4 por cada AVAD evitado en comparación con el control de rutina en Floridablanca. El modelo probabilístico indicó que el sistema fue costo-efectivo en el 70 % de las 10.000 iteraciones para un umbral entre 1 y 3 PIB per cápita. Conclusiones. El programa VECTOS fue muy costo-efectivo en el municipio de San Juan de Girón. Su uso puede adoptarse en otros municipios del país donde las enfermedades transmitidas por A. aegypti son endémicas.

Cost-effectiveness of community mobilization (Camino Verde) for dengue prevention in Nicaragua and Mexico: A cluster randomized controlled trial.

BACKGROUND: We assessed the cost-effectiveness of Camino Verde, a community-based mobilization strategy to prevent and control dengue and other mosquito-borne diseases. A cluster-randomized controlled trial in Managua, Nicaragua, and in three coastal regions in Guerrero, Mexico (75 intervention and 75 control clusters), Camino Verde used non-governmental community health workers, called brigadistas, to support community mobilization. This donor-funded trial demonstrated reductions of 29.5% (95% confidence interval, CI: 3.8%-55.3%) on dengue infections and 24.7% (CI: 1.8%-51.2%) on self-reported cases. METHODS: We estimated program costs through a micro-costing approach and semi-structured questionnaires. We show results as incremental cost-effectiveness ratios (ICERs) for costs per disability-adjusted life-year (DALYs) averted and conducted probabilistic sensitivity analyses. FINDINGS: The Camino Verde trial spent US$16.72 in Mexico and $7.47 in Nicaragua per person annually. We found an average of 910 (CI: 487-1 353) and 500 (CI: 250-760) dengue cases averted annually per million population in Mexico and Nicaragua, respectively, compared to control communities. The ICER in Mexico was US$29 618 (CI: 13 869-66 898) per DALY averted, or 3.0 times per capita GDP. For Nicaragua, the ICER was US$29 196 (CI: 14294-72181) per DALY averted, or 16.9 times per capita GDP. INTERPRETATION: Camino Verde, as implemented in the research context, was marginally cost-effective in Mexico, and not cost-effective in Nicaragua, from a healthcare sector perspective. Nicaragua's low per capita GDP and the use of grant-funded management personnel weakened the cost-effectiveness results. Achieving efficiencies by incorporating Camino Verde activities into existing public health programs would make Camino Verde cost-effective.

Impacto económico del dengue en pacientes y familiares / Economic impact of dengue on patients and families

Introducción: En Cuba no se han estudiado suficientemente los gastos de bolsillo y la pérdida de calidad de vida relacionada con la salud (de pacientes con dengue y sus familiares. Objetivo: Describir la afectación de la calidad de vida, los costos no médicos directos (gastos de bolsillo) e indirectos de pacientes hospitalizados con dengue y sus familiares. Método: Estudio de descripción de costos desde la perspectiva de pacientes y familiares, para los hospitalizados con dengue en el Clínico Quirúrgico Salvador Allende, en noviembre de 2013. En enero-febrero de 2014 se aplicó un cuestionario cerrado de 173 preguntas. Se calcularon la pérdida promedio de calidad de vida relacionada con la salud, los costos no médicos directos y los costos indirectos. Resultados: Durante el episodio de dengue el grupo de edad más afectado fue el de 30-44 años. Predominaron las mujeres (63,3 por ciento). La calidad de vida relacionada con la salud se afectó sensiblemente pasando como promedio de 86,9 el día antes de la enfermedad a 27,8 el día que las personas se sintieron más enfermas. En el momento de la entrevista, el 51 por ciento de los pacientes percibían que no se habían recuperado de la enfermedad. Los pacientes estuvieron hospitalizados como promedio 5 días. Los gastos de bolsillo de pacientes y familiares ascendieron a 61,24 CUC (IC95 por ciento 43,23-79,25 CUC), en que el 66,2 por ciento fue en alimentación y el 13,6 por ciento en transporte. Las pérdidas promedio de ingreso fueron de 25,30 CUC para los pacientes y 4,50 CUC para los familiares. Los costos totales promedio por paciente fueron de 89,25 CUC (IC95 por ciento 67,33-110,29 CUC). Conclusiones: Se evidenció la pérdida de calidad de vida como consecuencia del dengue. Los gastos de bolsillo fueron altos y representan tres veces el valor del salario medio de la Provincia La Habana(AU)

Introduction: Health-related loss of quality of life among dengue patients and their relatives, and unforeseen family expenses incurred for this reason, have not been sufficiently studied in Cuba. Objective: Describe the impact on quality of life, as well as the non-medical direct and indirect unforeseen expenses incurred by patients hospitalized with dengue and their relatives. Method: A cost analysis study was conducted based on data provided by patients hospitalized with dengue in Salvador Allende Clinical Surgical Hospital and their relatives in November 2013. A closed-ended questionnaire of 173 questions was applied in January-February 2014. Estimation was made of average health-related loss of quality of life, direct non-medical costs and indirect costs. Results: The 30-44 years age group was the most harshly affected during the episode. There was a predominance of the female sex (63.3 percent). Health-related quality of life decreased dramatically from an average 86.9 the day before the disease to 27.8 on the day when patients felt the worst. At the time of the interview, 51 percent of the patients perceived that they had not recovered from the disease. Mean hospital stay was 5 days. Unforeseen patient and family expenses rose to 61.24 CUC (CI 95 percent; 43.23-79.25 CUC), of which 66.2 percent was spent on food and 13.6 percent on transport. Average income loss was 25.30 CUC for patients and 4.50 CUC for relatives. Total average cost per patient was 89.25 CUC (CI 95 percent 67.33-110.29 CUC). Conclusions: Evidence was found of loss of quality of life as a result of dengue. Unforeseen expenses were high, representing three times the mean salary in the province of Havana(AU)

Safety and costs of blood transfusion practices in dengue cases in Brazil.

BACKGROUND: Dengue is a public health problem, and noncompliance with World Health Organization (WHO) recommendations for blood transfusion components is frequently reported. Moreover, economic impact studies of the WHO recommendations on the use of blood transfusion are scarce. METHODS: We compared the cost and hospitalization time in a prospective observational study, by following hospitalised patients and analysing their medical records from 2010 and March 2016 to December 2017. We divided the patients into two groups: transfused (with or without WHO criteria for transfusion) and not transfused (with or without WHO criteria for transfusion). Generalised linear modelling was performed to identify the variable that could increase the costs and hospital stay. RESULTS: Among 323 patients, 52 were transfused, of whom 52% without criteria (n = 27), and 271 were not transfused, of which 4.4% (n = 12) with criteria. Hospitalisation costs were 41% higher in the transfused group without criteria than in those with criteria (median US$ 674.3 vs US$ 478 p = 0.293). Patients who were not transfused but met the WHO criteria for transfusion (n = 12) had longer mean hospitalisation time than did those who were not transfused (3.8±3.4 days versus 3.6±3.1 days; p = 0.022). The GLM analysis using hospital stay and costs as the dependent variable explained approximately 33.4% (R2 = 0.334) of the hospitalisation time and 79.3% (R2 = 0.793) of costs. Receiving a transfusion increased the hospitalization time by 1.29 days (p = 0.0007; IRR = 1.29), and the costs were 5.1 times higher than those without receiving blood components (IRR = 5.1; p< 0.001; median US$ 504.4 vs US$ 170.7). In contrast, patients who were transfused according to WHO criteria had a reduction in costs of approximately 96% (IRR = 0.044; p<0.001; ß = -3.12) compared to that for those who were not transfused according to WHO criteria (without criteria). CONCLUSION: Transfusion without following WHO recommendations increased the time and cost of hospitalisation.

Pérdida de calidad de vida y carga económica causada por dengue desde la perspectiva de pacientes y sus familiares / Loss of quality of life and economic burden caused by dengue fever from the perspective of patients and their families

Introducción: En Cuba hay pocos datos disponibles sobre la pérdida de calidad de vida relacionada con la salud y la carga económica para los pacientes de dengue y sus familiares. Objetivo: Describir la pérdida de calidad de vida relacionada con la salud y la carga económica del dengue para los pacientes y sus familiares. Métodos: Se aplicó un cuestionario a 92 pacientes adultos confirmados de dengue y hospitalizados en el Hospital Clínico Quirúrgico Docente Ambrosio Grillo de Santiago de Cuba, entre enero y octubre 2015; también se les aplicó a sus familias. Se calculó la pérdida promedio de calidad de vida a través de una escala analógica (0-100) y de los costos no médicos directos (gastos de bolsillo) e indirectos por paciente. Resultados: la pérdida global de calidad de vida fue de 67,9 por ciento en el peor momento de la enfermedad. El promedio de días autopercibidos hasta la recuperación fue 13,1. El promedio de visitas por paciente a los servicios ambulatorios antes de la hospitalización fue 1,3, y el policlínico resultó el servicio más utilizado. La estadía hospitalaria promedio fue 3,96 noches. Ningún enfermo presentó dengue grave. Los costos no médicos directos para los pacientes y sus familiares, fueron 7,95 USD (CUC). El 44,7 por ciento fue utilizado en transporte y 32,0 por ciento en alimentación, financiados principalmente con los ahorros personales y donaciones de familiares y amigos. Los costos indirectos promedio fueron 4,10 USD (CUC). Conclusión: Hubo una sustancial pérdida de calidad de vida durante la enfermedad. Los costos no médicos directos y los indirectos para los pacientes y familiares fueron bajos. La carga económica asumida por el gobierno es 12 veces mayor que estos(AU)

Introduction: Few data are available in Cuba about the loss of health-related quality of life and the economic burden caused by dengue fever to patients and their families. Objective: Describe the loss of health-related quality of life and the economic burden caused by dengue fever to patients and their families in Santiago de Cuba. Method: A questionnaire was applied to 92 adult patients with confirmed dengue fever admitted to Ambrosio Grillo Clinical Surgical University Hospital in Santiago de Cuba from January to October 2015. The questionnaire was also applied to their relatives. An analog scale (0-100) was used to estimate average loss of quality of life as well as indirect and direct non-medical costs expenses incurred by patients. Results: Global loss of quality of life was 67.9 percent at the worst stage of the condition. Average self-perceived days until recovery were 13.1. Average visits to outpatient services per patient before hospitalization were 1.3. The polyclinic was the most commonly used service. Average hospital stay was 3.96 nights. No patient had severe dengue fever. Direct non-medical expenses incurred by patients and their families were USD 7.95 (CUC), 44.7 percent of which were spent on transportation and 32.0 percent on food. These were mainly covered by personal savings and donations from relatives and friends. Average indirect expenses were USD 4.10 (CUC). Conclusion: There was considerable loss of quality of life during the disease. Patients and their families incurred low non-medical direct and indirect expenses. The economic burden undertaken by the government is 12 times as high(AU)

Cost of illness and program of dengue: A systematic review.

BACKGROUND: Studies on dengue related to the cost of illness and cost of the program are factors to describe the economic burden of dengue, a neglected disease that has global importance in public health. These studies are often used by health managers in optimizing financial resources. A systematic review of studies estimating the cost of dengue was carried out, comparing the costs between the studies and examining the cost drivers regarding the methodological choices. METHODS: This study was done according to the guidelines of the Centre for Reviews and Dissemination (CRD). Several databases were searched: Medline, Virtual Health Library and CRD. Two researchers, working independently, selected the studies and extracted the data. The quality of the methodology of the individual studies was achieved by a checklist of 29 items based on protocols proposed by the British Medical Journal and Consolidated Health Economic Evaluation Reporting Standards. A qualitative and quantitative narrative synthesis was performed. RESULTS: A literature search yielded 665 publications. Of these, 22 studies are in accordance with previously established inclusion criteria. The cost estimates were compared amongst the studies, highlighting the study design, included population and comparators used (study methodology). The component costs included in the economic evaluation were based on direct and indirect costs, wherein twelve studies included both costs, twelve studies adopted the societal perspective and ten studies used the perspective of the public health service provider, or of a private budget holder. CONCLUSION: This study showed that the cost of dengue in 18 countries generated approximately US$ 3.3 billion Purchasing Power Parity (PPP) in 2015. This confirms that the burden of dengue has a great economic impact on countries with common socioeconomic characteristics and similarities in health systems, particularly developing countries, indicating a need for further studies in these countries.

[Costs of an Aedes aegypti vector control program in municipalities in Colombia: a case study in Girón and Guadalajara de Buga, 2016]. / Costos de un programa de control del vector Aedes aegypti en municipios de Colombia: el caso de Girón y Guadalajara de Buga, 2016.

The aim of this study was to measure the costs of vector-borne disease control programs at the local level in Colombia (2016). A cost analysis was performed for this purpose from the policymaker's perspective in the municipalities (counties) of Girón and Guadalajara de Buga, specifically for the Aedes aegypti control program, the principal mosquito vector of dengue, Zika, and chikungunya. The analysis involved the quantification of all the costs required for each of the prevention and control strategies in vector-borne diseases. The costs were classified as operating and capital costs, and for purposes of comparison the costs were also calculated per case and per capita. The programs' total estimated costs were USD 146,651 in Girón and USD 97,936 in Guadalajara de Buga. Per capita cost was USD 0.88 in Girón and USD 0.99 in Guadalajara de Buga. In general, the predominant cost strategies were chemical spraying of adult mosquitos, accounting for 26% of the total costs in Girón and 47% in Guadalajara de Buga, with personnel representing 40% of the total costs for this strategy in Girón and 66% of the operating costs in Guadalajara de Buga.

El objetivo de este estudio fue cuantificar los costos de los programas de control de enfermedades transmitidas por vectores a nivel local en Colombia (2016). Para ello, fue realizado un análisis de costos desde la perspectiva del hacedor de política en los municipios de Girón y Guadalajara de Buga, específicamente para el programa de control del Aedes aegypti, principal vector trasmisor del dengue, Zika y chikungunya. Este análisis implicó la cuantificación de todos los costos requeridos para cada una de las estrategias de prevención y control de enfermedades transmitidas por vectores. Los costos fueron clasificados en recurrentes y de capital, además, con fines comparativos se obtuvo el costo por caso y a nivel per cápita. El costo total estimado de los programas fue de USD 146.651 en el municipio de Girón y USD 97.936 en el municipio de Guadalajara de Buga; a nivel per cápita el costo fue de USD 0,88 en Girón y en Guadalajara de Buga fue de USD 0,99. En general, las estrategias predominantes en costos fueron el control químico de vectores adultos, con un 26% del total de los costos en Girón y un 47% en Guadalajara de Buga, esta fue intensiva en costos recurrentes, con un costo de personal 40% del total de costos para esta estrategia en Girón y un 66% de costos operacionales en Guadalajara de Buga.

O objetivo deste estudo foi quantificar os custos dos programas de controle de doenças transmitidas por vetores ao nível local na Colômbia em (2016). Para isso, foi realizada uma análise de custos desde a perspectiva do criador de políticas nos municípios de Girón e Guadalajara de Buga, especificamente para o programa de controle do Aedes aegypti, principal vector transmissor da dengue, Zika e chikungunya. Esta análise implicou a quantificação de todos os custos requeridos para cada uma das estratégias de prevenção e controle de doenças transmitidas por vetores. Os custos foram classificados em recorrentes e do capital, ademais, para fins comparativos foi obtido o custo por caso e nível per capita. O custo total estimado dos programas foi de USD 146.651 no Município de Girón e USD 97.936 no Município de Guadalajara de Buga; ao nível per capita o custo foi de USD 0,88 em Girón e em Guadalajara de Buga foi de USD 0,99. Em geral, as estratégias predominantes em custos foram o controle químico de vetores adultos, com um 26% do total dos custos em Girón e um 47% em Guadalajara de Buga, essa foi intensiva em custos recorrentes, com um custo de pessoal de um 40% do total de custos para esta estratégia em Girón e um 66% de custos operacionais em Guadalajara de Buga.

Economic impact of dengue in Mexico considering reported cases for 2012 to 2016.

BACKGROUND: Given that dengue disease is growing and may progress to dengue hemorrhagic fever (DHF), data on economic cost and disease burden are important. However, data for Mexico are limited. METHODOLOGY/PRINCIPAL FINDINGS: Burden of dengue fever (DF) and DHF in Mexico was assessed using official databases for epidemiological information, disabilities weights from Shepard et al, the reported number of cases and deaths, and costs. Overall costs of dengue were summed from direct medical costs to the health system, cost of dengue to the patient (out-of-pocket expenses [medical and non-medical], indirect costs [loss of earnings, patient and/or caregiver]), and other government expenditures on prevention/surveillance. The first three components, calculated as costs per case by a micro-costing approach (PAATI; program, actions, activities, tasks, inputs), were scaled up to overall cost using epidemiology data from official databases. PAATI was used to calculate cost of vector control and prevention, education, and epidemiological surveillance, based on an expert consensus and normative construction of an ideal scenario. Disability-adjusted life years (DALYs) for Mexico in 2016 were calculated to be 2283.46 (1.87 per 100,000 inhabitants). Overall economic impact of dengue in Mexico for 2012 was US$144 million, of which US$44 million corresponded to direct medical costs and US$5 million to the costs from the patient's perspective. The estimated cost of prevention/surveillance was calculated with information provided by federal government to be US$95 million. The overall economic impact of DF and DHF showed an increase in 2013 to US$161 million and a decrease to US$133, US$131 and US$130 million in 2014, 2015 and 2016, respectively. CONCLUSIONS/SIGNIFICANCE: The medical and economic impact of dengue were in agreement with other international studies, and highlight the need to include governmental expenditure for prevention/surveillance in overall cost analyses given the high economic impact of these, increasing the necessity to evaluate its effectiveness.

Economic and epidemiological impact of dengue illness over 16 years from a public health system perspective in Brazil to inform future health policies including the adoption of a dengue vaccine.

INTRODUCTION: Dengue is a serious global health problem endemic in Brazil. Consequently, our aim was to measure the costs and disease burden of symptomatic dengue infections in Brazil from the perspective of the Brazilian Public Health System (SUS) between 2000 and 2015, using Brazilian public health system databases. Specific age group incidence estimates were used to calculate the disability-adjusted life years (DALYs) to gain a better understanding of the disease burden. Areas covered: SUS spent almost USD159 million and USD10 million to treat dengue and severe dengue, respectively, between 2000 and 2015. This is principally hospitalization costs, with the majority of patients self-treated at home with minor symptoms. The average notification rate for dengue was 273 per 100,000 inhabitants and three per 100,000 for severe dengue, with annual DALYs estimates ranging between 72.35 and 6,824.45 during the 16 years. Expert commentary: The epidemiological and morbidity burden associated with dengue is substantial in Brazil, with costs affected by the fact that most patients self-treat at home with these costs not included in SUS. The Brazilian government urgently needs to proactively evaluate the real costs and clinical benefits of any potential dengue vaccination program by the National Immunization Program to guide future decision-making.

Dengue incidence and associated costs in the periods before (2000-2008) and after (2009-2013) the construction of the hydroelectric power plants in Rondônia, Brazil. / Incidência de dengue e custos associados, nos períodos anterior (2000-2008) e posterior (2009-2013) à construção das usinas hidrelétricas em Rondônia.

OBJECTIVE: to describe the incidence of dengue cases and associated costs in the period before and after the construction of the Jirau and Santo Antônio hydroelectric power plants (HPP), in Rondônia State, Brazil. METHODS: economic evaluation study, based on data from the Notifiable Diseases Information System (SINAN) and the National Hospital Information System (SIH/SUS); dengue direct costs were calculated and segmented regression analysis was carried out. RESULTS: dengue incidence mean was higher in the period after HPP construction (880.29/100,000 inhabitants) than before them (356.34/100,000 inhabitants) (p≤0.05); direct costs were estimated at US$3.47 million in the pre-construction period and US$7.1 million in the post-construction period. CONCLUSION: there was an increase in the incidence and direct costs of dengue after HPP construction; the environmental licensing process should include more detailed health impact assessments.

Dengue endemic and its impact on the gross national product of BRAZILIAN'S economy.

In history disease has caused social and economic damage. Dengue is an illness typically found in the tropics that has affected more and more people. In Brazil, according to the Brazilian Institute of Geography and Statistics (IBGE), in 2013 at least 12.9% of the population (25.8 million) reported already having had dengue in their life. So, how wide are the economic impacts that dengue's contagion has on the gross national product? Using Leontief's method, it became possible to estimate the direct and indirect impact on the workforce and output by one country. Workforce absenteeism reduced the national productiveness and welfare state where we found maximum inoperability of 0.027% and a minimum of 0.002%. This paper develops a methodology for estimation of the impact dengue has incurred in each sector of an economy; designing a ranking with sectors that have been more affected and forecasting the propagation of the endemic throughout a region. This research measures the impact of dengue on economy, the result was that the total loss of the Brazilian economy in 2013 was around BRL 1,023,174,876.83; the importance of 0.02% of the Gross Domestic Product.

Costos de un programa de control del vector Aedes aegypti en municipios de Colombia: el caso de Girón y Guadalajara de Buga, 2016 / Costs of an Aedes aegypti vector control program in municipalities in Colombia: a case study in Girón and Guadalajara de Buga, 2016 / Custos de um programa de controle ao vetor Aedes aegypti em municípios da Colômbia: o caso de Girón e Guadalajara de Buga, 2016

Resumen: El objetivo de este estudio fue cuantificar los costos de los programas de control de enfermedades transmitidas por vectores a nivel local en Colombia (2016). Para ello, fue realizado un análisis de costos desde la perspectiva del hacedor de política en los municipios de Girón y Guadalajara de Buga, específicamente para el programa de control del Aedes aegypti, principal vector trasmisor del dengue, Zika y chikungunya. Este análisis implicó la cuantificación de todos los costos requeridos para cada una de las estrategias de prevención y control de enfermedades transmitidas por vectores. Los costos fueron clasificados en recurrentes y de capital, además, con fines comparativos se obtuvo el costo por caso y a nivel per cápita. El costo total estimado de los programas fue de USD 146.651 en el municipio de Girón y USD 97.936 en el municipio de Guadalajara de Buga; a nivel per cápita el costo fue de USD 0,88 en Girón y en Guadalajara de Buga fue de USD 0,99. En general, las estrategias predominantes en costos fueron el control químico de vectores adultos, con un 26% del total de los costos en Girón y un 47% en Guadalajara de Buga, esta fue intensiva en costos recurrentes, con un costo de personal 40% del total de costos para esta estrategia en Girón y un 66% de costos operacionales en Guadalajara de Buga.

Abstract: The aim of this study was to measure the costs of vector-borne disease control programs at the local level in Colombia (2016). A cost analysis was performed for this purpose from the policymaker's perspective in the municipalities (counties) of Girón and Guadalajara de Buga, specifically for the Aedes aegypti control program, the principal mosquito vector of dengue, Zika, and chikungunya. The analysis involved the quantification of all the costs required for each of the prevention and control strategies in vector-borne diseases. The costs were classified as operating and capital costs, and for purposes of comparison the costs were also calculated per case and per capita. The programs' total estimated costs were USD 146,651 in Girón and USD 97,936 in Guadalajara de Buga. Per capita cost was USD 0.88 in Girón and USD 0.99 in Guadalajara de Buga. In general, the predominant cost strategies were chemical spraying of adult mosquitos, accounting for 26% of the total costs in Girón and 47% in Guadalajara de Buga, with personnel representing 40% of the total costs for this strategy in Girón and 66% of the operating costs in Guadalajara de Buga.

Resumo: O objetivo deste estudo foi quantificar os custos dos programas de controle de doenças transmitidas por vetores ao nível local na Colômbia em (2016). Para isso, foi realizada uma análise de custos desde a perspectiva do criador de políticas nos municípios de Girón e Guadalajara de Buga, especificamente para o programa de controle do Aedes aegypti, principal vector transmissor da dengue, Zika e chikungunya. Esta análise implicou a quantificação de todos os custos requeridos para cada uma das estratégias de prevenção e controle de doenças transmitidas por vetores. Os custos foram classificados em recorrentes e do capital, ademais, para fins comparativos foi obtido o custo por caso e nível per capita. O custo total estimado dos programas foi de USD 146.651 no Município de Girón e USD 97.936 no Município de Guadalajara de Buga; ao nível per capita o custo foi de USD 0,88 em Girón e em Guadalajara de Buga foi de USD 0,99. Em geral, as estratégias predominantes em custos foram o controle químico de vetores adultos, com um 26% do total dos custos em Girón e um 47% em Guadalajara de Buga, essa foi intensiva em custos recorrentes, com um custo de pessoal de um 40% do total de custos para esta estratégia em Girón e um 66% de custos operacionais em Guadalajara de Buga.

A multi-country study of the economic burden of dengue fever: Vietnam, Thailand, and Colombia.

BACKGROUND: Dengue fever is a major public health concern in many parts of the tropics and subtropics. The first dengue vaccine has already been licensed in six countries. Given the growing interests in the effective use of the vaccine, it is critical to understand the economic burden of dengue fever to guide decision-makers in setting health policy priorities. METHODS/PRINCIPAL FINDINGS: A standardized cost-of-illness study was conducted in three dengue endemic countries: Vietnam, Thailand, and Colombia. In order to capture all costs during the entire period of illness, patients were tested with rapid diagnostic tests on the first day of their clinical visits, and multiple interviews were scheduled until the patients recovered from the current illness. Various cost items were collected such as direct medical and non-medical costs, indirect costs, and non-out-of-pocket costs. In addition, socio-economic factors affecting disease severity were also identified by adopting a logit model. We found that total cost per episode ranges from $141 to $385 for inpatient and from $40 to $158 outpatient, with Colombia having the highest and Thailand having the lowest. The percentage of the private economic burden of dengue fever was highest in the low-income group and lowest in the high-income group. The logit analyses showed that early treatment, higher education, and better knowledge of dengue disease would reduce the probability of developing more severe illness. CONCLUSIONS/SIGNIFICANCE: The cost of dengue fever is substantial in the three dengue endemic countries. Our study findings can be used to consider accelerated introduction of vaccines into the public and private sector programs and prioritize alternative health interventions among competing health problems. In addition, a community would be better off by propagating the socio-economic factors identified in this study, which may prevent its members from developing severe illness in the long run.

Cost-Effectiveness of the Strategies to Reduce the Incidence of Dengue in Colima, México.

Dengue fever is considered to be one of the most important arboviral diseases globally. Unsuccessful vector-control strategies might be due to the lack of sustainable community participation. The state of Colima, located in the Western region of Mexico, is a dengue-endemic area despite vector-control activities implemented, which may be due to an insufficient health economic analysis of these interventions. A randomized controlled community trial took place in five urban municipalities where 24 clusters were included. The study groups (n = 4) included an intervention to improve the community participation in vector control (A), ultra-low volume (ULV) spraying (B), both interventions (AB), and a control group. The main outcomes investigated were dengue cumulative incidence, disability-adjusted life years (DALYs), and the direct costs per intervention. The cumulative incidence of dengue was 17.4%, A; 14.3%, B; 14.4%, AB; and 30.2% in the control group. The highest efficiency and effectiveness were observed in group B (0.526 and 6.97, respectively) and intervention A was more likely to be cost-effective ($3952.84 per DALY avoided) followed by intervention B ($4472.09 per DALY avoided). Our findings suggest that efforts to improve community participation in vector control and ULV-spraying alone are cost-effective and may be useful to reduce the vector density and dengue incidence.