Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; School of Medicine, University of California, San Francisco, CA, USA.
Lancet Infect Dis. 2017 Mar;17(3):e70-e78. doi: 10.1016/S1473-3099(16)30545-X. Epub 2017 Feb 7.
The burden of dengue is large and growing. More than half of the global population lives in areas with risk of dengue transmission. Uncertainty in burden estimates, however, challenges policy makers' ability to set priorities, allocate resources, and plan for interventions. In this report, the first in a Series on dengue, we explore the estimations of disease and economic burdens of dengue, and the major estimation challenges, limitations, and sources of uncertainty. We also reflect on opportunities to remedy these deficiencies. Point estimates of apparent dengue infections vary widely, although the confidence intervals of these estimates overlap. Cost estimates include different items, are mostly based on a single year of data, use different monetary references, are calculated from different perspectives, and are difficult to compare. Comprehensive estimates that decompose the cost by different stakeholders (as proposed in our framework), that consider the cost of epidemic years, and that account for productivity and tourism losses, are scarce. On the basis of these estimates, we propose the most comprehensive framework for estimating the economic burden of dengue in any region, differentiated by four very different domains of cost items and by three potential stakeholders who bear the costs. This framework can inform future estimations of the economic burden of dengue and generate demand for additional routine administrative data collection, or for systematic incorporation of additional questions in nationally representative surveys in dengue-endemic countries. Furthermore, scholars could use the framework to guide scenario simulations that consider ranges of possible values for cost items for which data are not yet available. Results would be valuable to policy makers and would also raise awareness among communities, potentially improving dengue control efforts.
登革热负担沉重且不断增加。超过一半的全球人口生活在有登革热传播风险的地区。然而，由于对疾病负担的估计存在不确定性，这给决策者确定优先事项、分配资源和规划干预措施带来了挑战。在本报告中，也是关于登革热的系列报告中的第一份报告，我们探讨了登革热疾病和经济负担的估计，以及主要的估计挑战、局限性和不确定性来源。我们还反思了弥补这些缺陷的机会。显性登革热感染的点估计值差异很大，尽管这些估计的置信区间重叠。成本估计包括不同的项目，主要基于一年的数据，使用不同的货币参考，从不同的角度计算，难以比较。综合估计值按不同利益相关者（如我们的框架所建议的）分解成本，考虑流行年份的成本，并考虑生产力和旅游业损失，这种估计值很少。基于这些估计，我们提出了在任何地区估计登革热经济负担的最全面框架，按四个非常不同的成本项目领域和三个潜在承担成本的利益相关者进行区分。该框架可以为未来估计登革热的经济负担提供信息，并产生对额外常规行政数据收集的需求，或在登革热流行国家的全国代表性调查中系统纳入额外问题的需求。此外，学者们可以使用该框架来指导考虑成本项目可能值范围的情景模拟，这些成本项目的数据尚不可用。研究结果对决策者很有价值，也会引起社区的关注，从而可能改善登革热的控制工作。
