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. 2015 Mar 18;9(3):e0003547.
doi: 10.1371/journal.pntd.0003547. eCollection 2015 Mar.

Economic and disease burden of dengue in Mexico

Eduardo A Undurraga  1 , Miguel Betancourt-Cravioto  2 , José Ramos-Castañeda  3 , Ruth Martínez-Vega  4 , Jorge Méndez-Galván  5 , Duane J Gubler  6 , María G Guzmán  7 , Scott B Halstead  8 , Eva Harris  9 , Pablo Kuri-Morales  10 , Roberto Tapia-Conyer  2 , Donald S Shepard  1
Affiliations

Economic and disease burden of dengue in Mexico

Eduardo A Undurraga et al. PLoS Negl Trop Dis. .

Abstract

Background: Dengue imposes a substantial economic and disease burden in most tropical and subtropical countries. Dengue incidence and severity have dramatically increased in Mexico during the past decades. Having objective and comparable estimates of the economic burden of dengue is essential to inform health policy, increase disease awareness, and assess the impact of dengue prevention and control technologies.

Methods and findings: We estimated the annual economic and disease burden of dengue in Mexico for the years 2010-2011. We merged multiple data sources, including a prospective cohort study; patient interviews and macro-costing from major hospitals; surveillance, budget, and health data from the Ministry of Health; WHO cost estimates; and available literature. We conducted a probabilistic sensitivity analysis using Monte Carlo simulations to derive 95% certainty levels (CL) for our estimates. Results suggest that Mexico had about 139,000 (95%CL: 128,000-253,000) symptomatic and 119 (95%CL: 75-171) fatal dengue episodes annually on average (2010-2011), compared to an average of 30,941 symptomatic and 59 fatal dengue episodes reported. The annual cost, including surveillance and vector control, was US$170 (95%CL: 151-292) million, or $1.56 (95%CL: 1.38-2.68) per capita, comparable to other countries in the region. Of this, $87 (95%CL: 87-209) million or $0.80 per capita (95%CL: 0.62-1.12) corresponds to illness. Annual disease burden averaged 65 (95%CL: 36-99) disability-adjusted life years (DALYs) per million population. Inclusion of long-term sequelae, co-morbidities, impact on tourism, and health system disruption during outbreaks would further increase estimated economic and disease burden.

Conclusion: With this study, Mexico joins Panama, Puerto Rico, Nicaragua, and Thailand as the only countries or areas worldwide with comprehensive (illness and preventive) empirical estimates of dengue burden. Burden varies annually; during an outbreak, dengue burden may be significantly higher than that of the pre-vaccine level of rotavirus diarrhea. In sum, Mexico's potential economic benefits from dengue control would be substantial.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: This study was partially funded by a research agreement from Sanofi Pasteur to Brandeis University. This does not alter our adherence to all PLOS NTDs policies on sharing data and materials.

Figures

Fig 1
Fig 1. Age distribution of reported dengue episodes, 2010–2011.
Notes: The graph shows the percentage of reported episodes in each 10-year age category, from 0–9 through 90–99, using the midpoint of each category.
Fig 2
Fig 2. Distribution of the economic burden of dengue in Mexico by component, 2010–2011.
Notes: Costs were adjusted to 2012 US dollars, using gross domestic product (GDP) deflators. [58] *Due to limited availability of data, vector control and surveillance costs for the year 2011 were estimated based on the average annual budget allocated by the Mexican Ministry of Health from the previous two years (2009 and 2010).
Fig 3
Fig 3. Variation in total economic burden of dengue based on listed parameters included in the sensitivity analysis (average for years 2010 and 2011).
Notes: The vertical line shows the point estimate for the average total economic burden of dengue ($170 million). The variation for each parameter corresponds to the 95% certainty level obtained through the computation of 10,000 Monte Carlo simulations for each parameter, and for the simultaneous variation of all parameters (bar at the top). A summary of the main parameters, assumed distributions and data sources are shown in Table 5.
Fig 4
Fig 4. Estimated symptomatic and fatal dengue episodes and economic and disease burden, 1995–2011.
Notes: Estimated numbers of dengue episodes are based on refined surveillance data using expansion factors from the Morelos prospective cohort study.a Cost estimates correspond to the average annual economic burden per capita for dengue illness and death (in 2012 US dollars) and do not include surveillance and vector control costs.b Disability adjusted life years (DALYs) are per million population.c Average number of cases of symptomatic dengue infection reported to the Ministry of Health (not adjusted for underreporting).
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References

    1. Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, et al. (2012) Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis 6: e1760 10.1371/journal.pntd.0001760 - DOI - PMC - PubMed
    1. Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, et al. (2013) The global distribution and burden of dengue. Nature 496: 504–507. 10.1038/nature12060 - DOI - PMC - PubMed
    1. Guzman MG, Halstead SB, Artsob H, Buchy P, Farrar J, et al. (2010) Dengue: a continuing global threat. Nat Rev Microbiol 8: S7–S16. 10.1038/nrmicro2460 - DOI - PMC - PubMed
    1. Simmons CP, Farrar JJ, Nguyen VVC, Wills B (2012) Current concepts: dengue. N Engl J Med 366: 1423–1432. 10.1056/NEJMra1110265 - DOI - PubMed
    1. Gómez-Dantés H, Farfán-Ale JA, Sarti E (2014) Epidemiological trends of dengue disease in Mexico (2000–2011): A systematic literature search and analysis. PLoS Negl Trop Dis 8: e3158 10.1371/journal.pntd.0003158 - DOI - PMC - PubMed

Publication types

Grants and funding

This study was supported in part by a research agreement between Sanofi Pasteur and Brandeis University. The study was also partially supported by UBS Optimus Foundation through University of California, Berkeley, and the Carlos Slim Health Institute. The cohort study in Morelos was supported in part by the Pfizer Institute for Science (Epidemiological Research Fund prize in 2010) and Consejo Nacional de Ciencia y Tecnología de México, CONACyT, (Sectorial Fund for Research on Social Health and Security 138511). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.