The cost of dengue fever challenges public health and national economies

New study strengthens the case for development of vaccine to prevent mosquitoe-borne virus

A new study of the disease burden of dengue fever in Malaysia strengthens the case for development of a vaccine against the mosquito-borne illness.

Despite the nation’s efforts at treatment and control, 10,000 cases are reported each year at a l cost of almost $13 million, slightly less than half for vector control and the rest for treating hospitalized patients with dengue fever, an often painful and sometimes fatal virus.

These costs are equivalent to 940,000 lost workdays of output, said lead author Professor Donald Shepard, a health economist at Brandeis University’s Heller School for Social Policy and Management. In contrast, a prior study by Shepard and other researchers found that a dengue vaccine, if development proceeds as hoped, would offset 87 percent of treatment costs for all of Southeast Asia, as well as reduce the cost of vector control with fumigants and insecticides.

In effect, a vaccine made widely available would cost only marginally more than current treatment and control efforts, but with dramatic gains in public health and economic output.

“This study dramatically strengthens the case for developing and implementing an affordable vaccine wherever dengue is common,” said Shepard. Although no vaccine is yet commercially available, several approaches are under development.

The first findings from this research, to be presented Thursday at the Symposium on National Health Accounts as part of the International Health Economics Association conference in Barcelona, Spain, evaluated the cost of treatment and control of dengue fever from 2000-2004 in Malaysia. Professor Lucy Lum of the University of Malaya and Dr. Jose Suaya of Brandeis co-authored the study.

“One hospitalized case of dengue fever costs one-fifth of Malaysia’s per capita gross national product (GNP)” noted Shepard. “The cost of treatment, the pain and suffering, the fear that a parent or child could die from this virus – all these facts are reasons why dengue is a salient candidate for vaccine development,” Shepard said.

Currently, each person hospitalized with dengue fever or dengue hemorrhagic fever in Malaysia costs about $718 to treat. About 70 percent of the cost is paid for by the government, and the rest by insurers and individual households. This cost per patient is equivalent to 53 days of lost economic output, according to the study.

“Our study suggests just how devastating dengue is to economies and people, and by extension, how important it is to start thinking strategically about the most effective way to reduce the myriad costs of this illness,” Shepard said. Dengue is endemic in much of Southeast Asia, Latin America and the Caribbean. Urban areas tend to be most affected because mosquitoes that transmit dengue live near people and breed in standing water found in discarded tires, old cans, flower pots, water tanks and other man-made containers.

In Southeast Asia dengue fever causes an estimated 27 million infections, 6 million illnesses, 400,000 hospitalizations and 3,000 deaths annually. In the Americas, 267,050 clinical cases and 71 deaths were reported in 2004, according to the Pan American Health Organization. Brazil reported the most cases in the region that year.

The study was sponsored by the Pediatric Dengue Vaccine Initiative, an organization created in 2002 to accelerate the development and use of a safe and effective dengue vaccine.

Brandeis University is currently managing dengue disease burden studies, which examine the economic burden of disease on households, governments and others, in nine countries: six in Latin America and three in Southeast Asia.