By Dr. Dagna Constenla

Dengue is a painful and debilitating mosquito-borne virus affecting millions of people worldwide every year. Prior to 1970, the disease was endemic in just nine countries. Today it is endemic in more than 100 countries, and WHO estimates that 2.5 billion people are at risk of infection each year.

Dengue Costing Guidelines

Costing Dengue Cases and Outbreaks: A Guide to Current Practices and Procedures

As the global burden of dengue grows, so too does the realization of just how little we know about the health and economic toll of the disease. At the same time, the prospect of a licensed vaccine is growing near, and dengue-endemic countries will have to begin to consider whether or not to introduce the vaccine. An important question they must ask when weighing the costs against the benefits of vaccine introduction is, “how much does dengue cost?”

In response to the growing need to answer that question and lay the groundwork for vaccine decision making by endemic countries, the International Vaccine Access Center, as part of its work on the Dengue Vaccine Initiative (DVI), convened an expert panel in March 2012 to discuss and develop a standardized methodology for estimating costs of dengue in the Americas. The resulting guidelines, Costing Dengue Cases and Outbreaks: A Guide to Current Practices and Procedures, published late last month, aim to ensure robust assessment of the economic burden of dengue infections and to make the results of future dengue cost studies more comparable among Latin American countries. 

The guidelines highlight the many considerations that need to be taken into account when doing analysis to understand the overall economic burden borne by a community as a result of dengue, from understanding the health care system where the study is being conducted to determining the definition of a dengue outbreak. The expert panel concluded that, while there is no single theoretically correct approach to costing dengue, experts generally adhered to certain principles including:

  • The adoption of a societal (broad rather than individual) perspective;
  • The inclusion of all relevant costs and effects (direct medical and non-medical costs of treating a case of dengue, productivity loss of patient and caregiver, etc);
  • The use of an adequate sample size, and;
  • The optimal collection and valuation of unit cost data for use in multi-country settings (making sure that data collected from a variety of countries and settings is collected well and able to be compared).

Creation of these guidelines was just one piece of IVAC’s work on dengue. This spring we plan to convene leaders from Latin America to tackle another key challenge in dengue vaccine introduction – financing. We are also tasked, through the DVI, with linking epidemiologic and economic modeling to create a strategic demand forecast for dengue vaccines.

It is important to note that estimation of dengue costs is a new area in which there is little published literature and in which few of the guideline authors had practical experience. Dengue financing is also an area that experts are just now beginning to address. It is our hope that our work will spur further discussion and research that will help position countries to make well-informed decisions about vaccine introduction. We welcome your thoughts on the guidelines and other dengue costing and financing issues here, or via email to dconstenla@jhsph.edu.

Dagna Constenla, PhD, is the Director of Economics & Finance at IVAC.