Economic burden of dengue in Indonesia.

BACKGROUND: Dengue is associated with significant economic expenditure and it is estimated that the Asia Pacific region accounts for >50% of the global cost. Indonesia has one of the world's highest dengue burdens; Aedes aegypti and Aedes albopictus are the primary and secondary vectors. In the absence of local data on disease cost, this study estimated the annual economic burden during 2015 of both hospitalized and ambulatory dengue cases in Indonesia. METHODS: Total 2015 dengue costs were calculated using both prospective and retrospective methods using data from public and private hospitals and health centres in three provinces: Yogyakarta, Bali and Jakarta. Direct costs were extracted from billing systems and claims; a patient survey captured indirect and out-of-pocket costs at discharge and 2 weeks later. Adjustments across sites based on similar clinical practices and healthcare landscapes were performed to fill gaps in cost estimates. The national burden of dengue was extrapolated from provincial data using data from the three sites and applying an empirically-derived epidemiological expansion factor. RESULTS: Total direct and indirect costs per dengue case assessed at Yogyakarta, Bali and Jakarta were US$791, US$1,241 and US$1,250, respectively. Total 2015 economic burden of dengue in Indonesia was estimated at US$381.15 million which comprised US$355.2 million for hospitalized and US$26.2 million for ambulatory care cases. CONCLUSION: Dengue imposes a substantial economic burden for Indonesian public payers and society. Complemented with an appropriate weighting method and by accounting for local specificities and practices, these data may support national level public health decision making for prevention/control of dengue in public health priority lists.

Symptomatic Dengue Disease in Five Southeast Asian Countries: Epidemiological Evidence from a Dengue Vaccine Trial.

Dengue incidence has increased globally, but empirical burden estimates are scarce. Prospective methods are best-able to capture all severities of disease. CYD14 was an observer-blinded dengue vaccine study conducted in children 2-14 years of age in Indonesia, Malaysia, Thailand, the Philippines, and Vietnam. The control group received no vaccine and resembled a prospective, observational study. We calculated the rates of dengue according to different laboratory or clinical criteria to make inferences about dengue burden, and compared with rates reported in the passive surveillance systems to calculate expansion factors which describe under-reporting. Over 6,933 person-years of observation in the control group there were 319 virologically confirmed dengue cases, a crude attack rate of 4.6%/year. Of these, 92 cases (28.8%) were clinically diagnosed as dengue fever or dengue hemorrhagic fever by investigators and 227 were not, indicating that most symptomatic disease fails to satisfy existing case definitions. When examining different case definitions, there was an inverse relationship between clinical severity and observed incidence rates. CYD14's active surveillance system captured a greater proportion of symptomatic dengue than national passive surveillance systems, giving rise to expansion factors ranging from 0.5 to 31.7. This analysis showed substantial, unpredictable and variable under-reporting of symptomatic dengue, even within a controlled clinical trial environment, and emphasizes that burden estimates are highly sensitive to case definitions. These data will assist in generating disease burden estimates and have important policy implications when considering the introduction and health economics of dengue prevention and control interventions.

The economic impact of providing dengue vaccination in the workplace in Brazil / O impacto econômico da vacinação contra dengue no local de trabalho no Brasil

Objective: To estimate the economic value of implementing a workplace dengue vaccination program from an employer perspective. Methods: The cost of a vaccination program was compared with the economic benefits in terms of reduced absenteeism and presenteeism in companies in Brazil. Input data were obtained from published literature and national databases. The time horizon was five years, including a 2-year vaccination program. Sensitivity analyses were performed to evaluate the impact of key parameters' uncertainty. Results: 846 cases were simulated among the employees over five years, accountable for 2,112 sick leave days and 7,120 sick days at work. Assuming a coverage rate of 30%, vaccination reduced the number of sick leave days and sick days at work by 17.5% over five years compared to no vaccination. Considering an employee vaccine copayment of 50%, the levels of remaining investment per dose administered for the employer in the retail sector ranged from US$ 17.99 to US$ 27.99, according to different vaccine price scenarios, and from US$ 6.10 to US$ 16.10 in the service sector. In the energy sector, vaccination was cost-saving in all price scenarios, ranging from a profit for the employer of US$ 21.14 to US$ 31.14. Results were most sensitive to the level of co-payment, overall time horizon of the analysis, dengue incidence, and employee contribution to operating income. Conclusions: Dengue contributes a significant proportion of absenteeism and presenteeism in private companies. Our analysis suggests that dengue vaccination in the workplace may be considered as a valuable investment and, in some cases, a cost-saving option for employers.

Objetivo: Estimar o valor econômico da implementação de um programa de vacinação contra a dengue no local de trabalho sob a perspectiva do empregador. Métodos: O custo de um programa de vacinação foi comparado com os benefícios econômicos em termos de redução do absenteísmo e do presenteísmo em empresas no Brasil. Os dados foram baseados na literatura publicada e em bases de dados nacionais. O horizonte temporal foi de cinco anos, incluindo um programa de vacinação de dois anos. Foram realizadas análises de sensibilidade para avaliar o impacto das incertezas de parâmetros-chave. Resultados: Oitocentos e quarenta e seis casos foram simulados entre os empregados em cinco anos, os quais foram responsáveis por 2.112 dias de licença médica e 7.120 dias com a doença no ambiente de trabalho. Assumindo uma taxa de cobertura de 30%, a vacinação reduziu o número de dias de licença médica devido à doença e os dias com a doença no ambiente de trabalho em 17,5% ao longo de cinco anos em comparação com a não realização da vacinação. Considerando um copagamento da vacinação pelos funcionários de 50%, os níveis de investimento remanescente por dose administrada para o empregador no setor varejista variaram de US$ 17,99 a US$ 27,99 de acordo com diferentes cenários de preços da vacina e de US$ 6,10 a US$ 16,10 no setor de serviços. No setor de energia, a vacinação resultou em economia de custos em todos os cenários de preços, que vão desde uma economia para o empregador de US$ 21,14 até US$ 31,14. Os resultados foram mais sensíveis ao nível de copagamento, horizonte de tempo global da análise, incidência de dengue e contribuição dos funcionários para a receita operacional. Conclusões: A dengue contribui com uma parcela significativa do absenteísmo e do presenteísmo em empresas privadas. Nossa análise sugere que a vacinação contra dengue no local de trabalhopode ser considerada um investimento valioso e, em alguns casos, uma opção que traz economia para os empregadores.