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      Economic and Disease Burden of Dengue in Southeast Asia

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          Abstract

          Background

          Dengue poses a substantial economic and disease burden in Southeast Asia (SEA). Quantifying this burden is critical to set policy priorities and disease-control strategies.

          Methods and Findings

          We estimated the economic and disease burden of dengue in 12 countries in SEA: Bhutan, Brunei, Cambodia, East-Timor, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Viet Nam. We obtained reported cases from multiple sources—surveillance data, World Health Organization (WHO), and published studies—and adjusted for underreporting using expansion factors from previous literature. We obtained unit costs per episode through a systematic literature review, and completed missing data using linear regressions. We excluded costs such as prevention and vector control, and long-term sequelae of dengue. Over the decade of 2001–2010, we obtained an annual average of 2.9 million (m) dengue episodes and 5,906 deaths. The annual economic burden (with 95% certainty levels) was US$950m (US$610m–US$1,384m) or about US$1.65 (US$1.06–US$2.41) per capita. The annual number of disability-adjusted life years (DALYs), based on the original 1994 definition, was 214,000 (120,000–299,000), which is equivalent to 372 (210–520) DALYs per million inhabitants.

          Conclusion

          Dengue poses a substantial economic and disease burden in SEA with a DALY burden per million inhabitants in the region. This burden is higher than that of 17 other conditions, including Japanese encephalitis, upper respiratory infections, and hepatitis B.

          Author Summary

          Dengue fever, or break bone fever, is the most common infectious disease transmitted by a mosquito, and is a major economic and disease burden in endemic countries. Between 100–200 million (m) infections occur each year in more than 100 countries, resulting in about 20,000 deaths. Quantifying the burden of dengue is critical for policy makers to set policy priorities and make informed decisions about disease control. We estimated the economic and disease burden of dengue in 12 countries in Southeast Asia, using a consistent methodology that allows comparison among countries. We estimated an annual average of 2.9 m dengue episodes and 5,906 deaths. This amounts to an annual cost per capita of US$1.65 (0.03% GDP per capita in 2010), and a disease burden of 372 disability-adjusted life years (DALYs) per million inhabitants, a rate higher than that of 17 other conditions, including Japanese encephalitis, upper respiratory infections, and hepatitis B.

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          Author and article information

          Contributors
          Role: Editor
          Journal
          PLoS Negl Trop Dis
          PLoS Negl Trop Dis
          plos
          plosntds
          PLoS Neglected Tropical Diseases
          Public Library of Science (San Francisco, USA )
          1935-2727
          1935-2735
          February 2013
          21 February 2013
          : 7
          : 2
          Affiliations
          Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America
          Duke University-National University of Singapore, Singapore
          Author notes

          The authors have declared that no competing interests exist.

          Conceived and designed the experiments: DSS EAU YAH. Analyzed the data: DSS EAU. Wrote the paper: DSS EAU YAH.

          Article
          PNTD-D-12-00973
          10.1371/journal.pntd.0002055
          3578748
          23437406

          This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

          Page count
          Pages: 12
          Funding
          This article is part of a study to estimate the economic burden of dengue in Southeast Asia, funded by a contract from Sanofi Pasteur ( http://www.sanofipasteur.com/) to Brandeis University. Sanofi Pasteur had no control over the contents or publication of this article.
          Categories
          Research Article
          Biology
          Population Biology
          Epidemiology
          Economic Epidemiology
          Medicine
          Infectious Diseases
          Neglected Tropical Diseases
          Dengue Fever
          Viral Diseases
          Dengue
          Non-Clinical Medicine
          Health Economics
          Social and Behavioral Sciences
          Economics
          Human Capital
          Economics of Health

          Infectious disease & Microbiology

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