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La dengue dans les départements français d’Amérique

 | 
Raymond Corriveau
, 
Bernard Philippon
, 
André Yébakima

Synopsis and Recommendations

Synopsis – point 5. The economic impact of dengue

Texte intégral

Question 11. ASSESSING THE ECONOMIC IMPACT OF DENGUE IN ENDEMIC AND EPIDEMIC PERIODS

1How can the economic impact of dengue in endemic and epidemic periods be assessed?

2The panel did not address this question as no expert on this aspect in the region was found available. An interview was conducted with health economist Dr. Martin I. Meltzer, researcher at the Center for Disease Control in Atlanta. Dr. Meltzer has an international reputation as an expert on the economic cost of dengue in Asia and America.

*

3Although there have been few exhaustive studies, it has become commonplace, in specialist articles and in all the countries affected by dengue, the FDAs included, to bemoan the economic impact of dengue. This impact is due to:

  • the large number of people sick at one time and who, even with benign forms of the illness, are unable to work for at least a week;
  • the cost of treatment of severe forms in emergency wards, in-patient surveillance of cases liable to develop into severe forms, and ambulatory medical care for other forms of the disease;
  • the need for countries at risk of epidemics to permanently maintain comparatively costly epidemiological and entomological monitoring and analysis services (more than 200 vector control officers in the FDAs to treat larval sites and check homes); these services must also be permanently prepared for emergency operations, although even with such preparedness, emergency operations are more costly than routine ones;
  • the need to maintain a permanent capacity for community awareness raising or mobilization to help destroy vector breeding sites, and which can be intensified in the event of an epidemic alert.

4For the FDAs, it is not possible at present to distinguish the cost of dengue among health costs in general, or the additional cost of a dengue epidemic compared to routine health costs or compared to the cost of dengue surveillance between epidemics.

5An exhaustive study of the costs must take account of:

  • immediate direct costs of patient care: doctors' consultations, home or hospital care, cost of laboratory analyses, cost of prescribed drugs or self-medication, ambulance costs, home or other welfare assistance, etc.;
  • long-term direct costs, which in principle are not very great in the case of dengue;
  • indirect costs: workdays lost, possible laying off or school closure (childcare costs etc.), time spent consulting a doctor, time spent on formalities (e.g. filling in sickness insurance forms), home patient care. The age, family situation and professional status of the patient can obviously have a major impact on costs, especially when one person stopping work leads to others being laid off;
  • containment costs, i.e. public expenditure on prevention and containment of epidemics. This includes the budgets allocated to all routine epidemiological and entomological monitoring work, and routine community awareness work. It also covers all the costs of intensifying these activities in pre-epidemic and epidemic periods.

6To assess such a wide range of personal, collective and public expenses would require standardized surveys among many groups of individuals and organisations: patients and their families, doctors in hospitals and private practice, hospital administrations, laboratory managers, private paramedical staff, family welfare staff, health managers at various levels, private and official health insurance funds, local authority street cleaning and mosquito control managers, community awareness managers, etc.

7A thorough study would therefore require proven, complex protocols and an experienced, expert team.

8It would be a major multidisciplinary task and would need to be based on a solid foundation of sound epidemiological and socio-demographic data. It would have to be retroactive and cover a well-defined geographical unit over a period long enough to include at least one epidemic and one non-epidemic period, preferably several. To take account of variations in unit costs over time, and possibly from one geographical area to another, costs would have to be expressed using a standardized unit, probably DALY (disability-adjusted life year) or QALY (quality-adjusted life year).

9For the FDAs, such an evaluation would be of value both cognitively and in budget terms. It would provide reference data for assessing the comparative cost of the additions to the surveillance system that already seem necessary, or of future adjustments considered useful for adapting surveillance systems to changes in the pattern of the disease (endemic or epidemic). It could compare the cost of dengue with the costs of other public health problems, as has been done in Porto Rico.

  • 1 Martin I. Metzer et al., "Setting priorities for health needs, managing resources", in Quantitativ (...)

10The conduct of even a partial survey on the cost of dengue in the FDAs could benefit from experience gained in the Caribbean by the CDC in a noteworthy study1 on the same subject in Porto Rico in 1984-1994. Correctives would of course have to be applied to take account of differences in organisation, health care services, the socio-anthropological setting, the cost of living, etc.

Notes

1 Martin I. Metzer et al., "Setting priorities for health needs, managing resources", in Quantitative Solutions to Health Problems (Ed. S. M. Teutsch), Oxford University Press, 1998.

© IRD Éditions, 2003

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