Economic impact of dengue episode: multicenter study across four Brazilian regions

Transcription

1 Economic impact of dengue episode: multicenter study across four Brazilian regions First Regional Dengue Symposium Rio de Janeiro, November 2015 Celina Maria Turchi Martelli Visiting Researcher - CPqAM / Fiocruz- Pernambuco

2 2003:517 thousand : 1 million 2013: > 2 million

3 Dengue in America, Brazil Mexico Colombia Venezuela Four countries registered 80% of dengue cases J.L. San Martin / OPAS

4 Background Increased number of reported dengue cases in Brazil Cost studies in Brazil and Guideline: Cost of dengue cases in eight countries in the Americas and Asia (Suaya et al, 2009) Direct costs of dengue hospitalization in Brazil (Vieira, 2014) Guideline for Costing dengue cases and outbreaks (2012)

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6 Rev Panam Salud Publica 34(3), 2013

7 Economic impact of dengue episode in Brazil Objective: To evaluate the economic burden of dengue from the public payer and societal perspectives Sponsor: Sanofi Pasteur Institution: University of Pernambuco, Brazil Ethical clearance at national level: CONEP

8 Methods - Study Design Cohort: probable dengue cases Ambulatory/hospitalized Health System: Sectors Public and Private Perspectives: Public Payer: Direct medical costs Societal: Direct cost, direct non-medical costs, indirect costs Deaths Period of study: dengue transmission high/low

9 Study sites in Brazil Belém Teresina Recife Coordinator Center Goiânia City Population Incidence, 2013 (million) (1,000 inhab.) Goiania 1, Belo Horizonte 2, Rio de Janeiro 6, Teresina 1,2 2.2 Recife 1,5 2.7 Belem 1,4 1.3 Belo Horizonte Rio de Janeiro

10 Belém Teresina Recife Goiânia Rio de Janeiro Belo Horizonte

11 Methods - Interviews and Data management Phase 1. Hospital/ambulatory settings recruitment of patients, to obtain informed consent and schedule household interviews Phase 2. Household interview days after the onset of clinical symptoms

12 Quanto custa a Dengue para você e para a sociedade? Caso seja solicitado, colabore.

13 Methods - Data collection Questionnaire: multi-country cost study (Suaya et al, 2009) Patients interview: date of symptoms/signs, use of medical service, work/school absence, out-of-pocket expenses Hospitalized patients: data extracted from the patient s file

14 Methods - Costing dengue episode Ambulatory and hospital settings, public and private sectors Unit cost for medical visit for outpatients Public sector - SUS value (USD 4.85) Private sector - private health insurance value (USD 26.45) Direct cost of hospitalized patients: cost and resource use

15 Flowchart of the study Household interview 2,223 screened dengue cases 2,035 dengue cases 188 cases excluded 1,657 Ambulatory cases 378 Hospitalized cases Private sector n=513 Public sector n=1,144 Public sector n=217 Private sector n=161 Public payer perspective Direct costs Societal perspective Public and Private sectors Direct and Indirect costs

16 Dengue epidemiology in Brazil - September August 2013

17 Health care access (%) Health care access, Brazil D+E C2 C1 B2 B1 A1+A2 Economic classes Public Private

18 Cost per hospitalized dengue case (2013 US$)

19 Cost distribution of dengue episode (2013 US$) Ambulatory Hospital

20 Estimated costs of dengue in Brazil (2013 US$) Public payer perspective Without Expansion Factor With Expansion Factor Ambulatory 1.8 million cases 5.8 million cases (EF=3.2) Direct cost per case $ 64 (48-80) unit cost Cost $ 116 million (87-145) $ 371 million ( ) Hospital 201 thousand cases 322 thousand cases (EF=1.6) Direct cost per case $ 237 ( ) unit cost Cost $ 48 million (36-60) $ 76 million (57-96) Total cost $ 164 million ( ) $ 447 million ( ) Societal perspective Without Expansion Factor With Expansion Factor Ambulatory 1.8 million cases 5.8 million cases (EF=3.2) Cost per case $ 173 ( ) unit cost Cost $ 313 million ( ) $ 1,003 million (748-1,264) Hospital 201 thousand cases 322 thousand cases (EF=1.6) Cost per case $ 448 ( ) unit cost Cost $ 90 million (67-113) $ 144 million ( ) Total cost $ 404 million ( ) $ 1,147 million (855-1,445) Number of fatal cases 529 ( ) Fatal costs $ 65 million (48-81) Grand total cost $ 468 million ( ) $ 1,212 million (904-1,526)

21 Estimated cost of dengue (2013 US$)

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23 Acknowlegments Universidade de Pernambuco - UPE Centro de Pesquisa Aggeu Magalhães Fiocruz/PE Universidade Federal de Goiás - UFG Universidade Estadual do Piauí - UESPI Universidade do Estado do Rio de Janeiro UERJ Secretaria Municipal de Belo Horizonte- SMBH Universidade do Estado do Pará UEPA Institute of Health Technology - IATS Fellowships Grants CNPq Sanofi Pasteur for support

24 Researcher Team Celina Maria Turchi Martelli João Bosco Siqueira Junior Mirian Perpetua Palha Dias Parente Ana Laura de Sene Amancio Zara Consuelo Silva Oliveira Cynthia Braga Fabiano Geraldo Pimenta Junior Fanny Cortes Luciana Ribeiro Bahia Márcia Costa Ooteman Mendes Michelle Quarti Machado Rosa Noêmia Teixeira Siqueira Filha Wayner Vieira Souza Dagna Constenla Juan Guillermo Lopez

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26 Author, year of publication EF ambulatory EF hospital Sensitivity analysis Armien et al, 2008 EF = 6 EF = 6 Univariate (EF 1-10) Suaya et al, 2009 EF = 3 EF = 3 Univariate (EF 2, 3 e 6) Shepard et al, 2011 Brazil EF = 5 ; Colombia EF = 9 ; Nicaragua EF = 20,4 ; Panama EF = 6 ; Puerto Rico & other countries EF = 15 Brazil EF = 1.6 ; Colombia, Panama & Nicaragua EF = 2.3 ; Puerto Rico EF = 2.4 ; Other countries EF = 2.3 Probabilistic. Monte Carlo simulation Halasa et al, 2012 EF = 10 EF = 2.42 EF ambulatory : 5-27 Wettstein et al, 2012 Epidemic period EF = 10 cases DF (variation: 8-14) Endemic period EF = 20 (variation: 18-25) DHF cases, EF = 6 (variation 5-10) Probabilistic (Monte Carlo simulation), univariate

27 Cost per ambulatory dengue case (2013 US$)

28 Cost of illness Americas Braz Braz il Nicaragu il Puerto a Rico Colombi a Cuba Argentina Venezuel Venezuel a avenezuel a Panama Guatemal El a Salvador Braz il Ambulatory Hospital Medical Non-medical Indirect Total I$, 2014