Dengue is the most common arthropod borne infection among humans and it is caused by a RNA virus from the Flaviviridae family (1). The global foot print of Dengue is rapidly mounting, causing a huge public health challenge at present. With the lack of an appropriate vaccine, targeted therapeutic agents or effective vector control strategies, Dengue infection is leading to many adverse physical, psychological and economic repercussions (2). Further the global incidence of Dengue has amplified 30 fold throughout the past fifty years (3).
During the year 2018, total notifications received by the Epidemiology unit on Dengue was 51536. Out of that 10258 has been reported from Colombo District. Total confirmed as Dengue infection for the year 2018 was 32989 and out of that 21.7% (n = 7174) was reported from Colombo District. The second highest number was reported from Gampaha District which accounted for 11.5%. Majority were males (60.38%) and gender was not mentioned in 0.35% of cases (4). The total number of hospital admissions in 2015 was 29777, corresponding to 143 per 100,000 population. The case fatality rate was 0.2% which is showing a declining trend over the years (5).
Shepard et al., 6 highlights the importance of estimating the economic burden due to Dengue specific to the setting. According to them from 2001 to 2010, an average of 2.9 million Dengue cases per year and 5906 deaths in 12 countries in South East Asia (SEA) had been reported. According to their estimates of disease and economic burden of Dengue in 12 countries in SEA, Dengue costs 1.65 USD per person annually and the disease burden was estimated as 372 disability adjusted life years (DALYs) per million population. The DALYs are having a higher rate than several other illnesses including of upper respiratory tract infections and hepatitis B (6).
Shepard et al., 1 report the healthcare costs associated with Dengue illness in Malaysia. In Malaysia, there is a passive surveillance system and under-reporting is a major issue. To overcome that limitation, they have calculated costing elements considering numerous methods. They have calculated the economic burden of dengue illness from a societal perspective. Using an adjusted estimate of total dengue cases, per year they have estimated an economic burden of dengue illness of US$56 million per year, which is approximately US$2.03 per capita. They discuss that the overall economic burden of dengue illness would be even higher if they had included costs linked with dengue prevention and control activities, dengue surveillance, and long-term consequences of dengue.(1)
Senanayake et al., 7 reported the findings of the first costing study on Dengue illness which was conducted in the Lady Ridgeway Hospital for children in Colombo in 2012. A descriptive cross sectional study was conducted among 43 DHF patients and 87 DF patients selected randomly. Average system cost per patient of DHF and DF was LKR 24,856 (USD 191) and LKR 10,348 (USD 80) respectively. Direct and indirect medical and non-medical costs incurred by households were LKR 4,758 (USD 36.6) for DHF and LKR 3,965 (USD 30.5) for DF. Total cost per illness for an episode of DHF was LKR 29,744 (USD 228.8). Total cost per episode of DF was LKR 14,326 (USD 110.2). Average hospital stay of DHF and DF patients was 4.8 and 3.8 days correspondingly. (7)
Thalagal et al., 8 assessed the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo district, during the epidemic year of 2012 from the perspective of the Ministry of Health. The total cost of dengue control and for reported hospital admissions was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the major proportion of the total costs of dengue control activities (79%) and hospitalizations (46%). A per capita cost of US$0.42 for dengue control activities was estimated. The average costs per hospitalization fluctuated between US$216–609 for pediatric cases and between US$196–866 for adult cases conferring to severity of disease and treatment setting. (8)
Costing of an illness provides information at the micro- and macroeconomic levels, to decide on a suitable price of inventions in the diagnosis and management of an illness and also to estimate appropriate funds for health policies. (9) Considering the costs related to a country’s health system, both the systemic costs borne by the government and the costs abided by households are both important, since it is the total costs that define the ideal provision and utilization of health services. (10)
In Sri Lanka, Dengue infection has been a major public health concern since 1960. The preventive and the curative services place a financial burden on the state health sector (8). Further the household cost, mainly as out of pocket expenditure (OOPE) is an important cost component embedded with Dengue infection. It is one costing element included in the societal perspective. The household costs, are the expenses borne by the patient and his family due to the hospitalization of the patient with Dengue illness. It is described under two broad categories; direct costs and indirect costs. The direct costs are categorized into direct medical costs and direct non-medical costs. The medical costs are the costs incurred due to patient’s treatments, medications, investigations, etc. Non- medical direct costs include costs incurred for travelling, for caregiver, for special foods and for lodging. The indirect costs are based on the productivity loss by the patient or the household caregiver due to the illness (11). Non-medical costs and income losses are a larger financial burden than direct medical costs for households., Universal health coverage (UHC), incorporates the need for all individuals to receive quality health services without suffering financial hardship,. This study, focused on estimating the household costs (particularly the OOPE) incurred due to Dengue among adults who received institutional care in Sri Lanka.