Nhan Le Nguyen Thanh, Turner Hugo C, Khanh Truong Huu, Hung Nguyen Thanh, Lien Le Bich, Hong Nguyen Thi Thu, Nhu Le Nguyen Truc, Ny Nguyen Thi Han, Nguyet Lam Anh, Thanh Tran Tan, Van Hoang Minh Tu, Viet Ho Lu, Tung Trinh Huu, Phuong Tran Thi Lan, Devine Angela, Thwaites Guy, Chau Nguyen Van Vinh, Thwaites Louise, van Doorn H Rogier, Tan Le Van
Children's Hospital 1, Ho Chi Minh City, Vietnam.
Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
Open Forum Infect Dis. 2019 Jul 1;6(7). doi: 10.1093/ofid/ofz284.
Hand, foot, and mouth disease (HFMD) has become a major public health concern in the Asia-Pacific region. Knowledge of its economic burden is essential for policy makers in prioritizing the development and implementation of interventions.
A multi-hospital-based study was prospectively conducted at 3 major hospitals in Ho Chi Minh City, Vietnam, during 2016-2017. Data on direct and productivity costs were collected alongside clinical information and samples and demographic information from study participants.
A total of 466 patients were enrolled. Two hundred three of 466 (43.6%) patients lived in Ho Chi Minh City, and 72/466 (15.5%) had severe HFMD. An enterovirus was identified in 74% of 466 patients, with EV-A71, CV-A6, CV-A10, and CV-A16 being the most common viruses identified (236/466, 50.6%). The mean economic burden per case was estimated at US$400.80 (95% confidence interval [CI], $353.80-$448.90), of which the total direct (medical) costs accounted for 69.7%. There were considerable differences in direct medical costs between groups of patients with different clinical severities and pathogens (ie, EV-A71 vs non-EV-A71). In Vietnam, during 2016-2017, the economic burden posed by HFMD was US$90 761 749 (95% CI, $79 033 973-$103 009 756).
Our findings are of public health significance because for the first time we demonstrate that HFMD causes a substantial economic burden in Vietnam, and although multivalent vaccines are required to control HFMD, effective EV-A71 vaccine could substantially reduce the burden posed by severe HFMD. The results will be helpful for health policy makers in prioritizing resources for the development and implementation of intervention strategies to reduce the burden of HFMD.
手足口病（HFMD）已成为亚太地区主要的公共卫生问题。了解其经济负担对于政策制定者确定干预措施的制定和实施优先级至关重要。
2016年至2017年期间，在越南胡志明市的3家主要医院前瞻性地开展了一项基于多所医院的研究。收集了直接成本和生产力成本数据，以及来自研究参与者的临床信息、样本和人口统计学信息。
共纳入466例患者。466例患者中有203例（43.6%）居住在胡志明市，72/466例（15.5%）患有重症手足口病。466例患者中有74%检测出肠道病毒，其中肠道病毒A71型（EV-A71）、柯萨奇病毒A6型（CV-A6）、柯萨奇病毒A10型（CV-A10）和柯萨奇病毒A16型（CV-A16）是最常见的病毒（236/466，50.6%）。每例病例的平均经济负担估计为400.80美元（95%置信区间[CI]，353.80美元至448.90美元），其中直接（医疗）成本总计占69.7%。不同临床严重程度和病原体（即EV-A71与非EV-A71）的患者组之间直接医疗成本存在显著差异。在越南，2016年至2017年期间，手足口病造成的经济负担为90761749美元（95%CI，79033973美元至103009756美元）。
我们的研究结果具有公共卫生意义，因为我们首次证明手足口病在越南造成了巨大的经济负担，虽然控制手足口病需要多价疫苗，但有效的EV-A71疫苗可大幅减轻重症手足口病造成的负担。这些结果将有助于卫生政策制定者确定资源优先级，以制定和实施干预策略来减轻手足口病的负担。
