Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia.
Heller School for Social Management and Policy, Brandeis University, Waltham, Massachusetts.
Am J Trop Med Hyg. 2020 Nov;103(5):2029-2039. doi: 10.4269/ajtmh.19-0855.
Informed decisions concerning emerging technologies against dengue require knowledge about the disease's economic cost and each stakeholder's potential benefits from better control. To generate such data for Indonesia, we reviewed recent literature, analyzed expenditure and utilization data from two hospitals and two primary care facilities in Yogyakarta city, and interviewed 67 dengue patients from hospital, ambulatory, and not medically attended settings. We derived the cost of a dengue episode by outcome, setting, and the breakdown by payer. We then calculated aggregate Yogyakarta and national costs and 95% uncertainty intervals (95% UIs). Dengue costs per nonfatal case in hospital, ambulatory, not medically attended, and overall average settings were US$316.24 (95% UI: $242.30-$390.18), US$22.45 (95% UI: $14.12-$30.77), US$7.48 (95% UI: $2.36-$12.60), and US$50.41 (95% UI: $35.75-$65.07), respectively. Costs of nonfatal episodes were borne by the patient's household (37%), social contributors (relatives and friends, 20%), national health insurance (25%), and other sources (government, charity, and private insurance, 18%). After including fatal cases, the average cost per episode became $90.41 (95% UI: $72.79-$112.35). Indonesia had an estimated 7.535 (95% UI: 1.319-16.513) million dengue episodes in 2017, giving national aggregate costs of $681.26 (95% UI: $232.28-$2,371.56) million. Unlike most previous research that examined only the formal medical sector, this study included the estimated 63% of national dengue episodes that were not medically attended. Also, this study used actual costs, rather than charges, which generally understate dengue's economic burden in public facilities. Overall, this study found that Indonesia's aggregate cost of dengue was 73% higher than previously estimated, strengthening the need for effective control.
为了对登革热防治新技术做出明智决策,需要了解该病的经济成本以及各利益相关方通过加强控制可获得的潜在收益。为了在印度尼西亚生成此类数据,我们查阅了近期文献,分析了日惹市两家医院和两家初级保健机构的支出和利用数据,并对来自医院、门诊和未就医环境的 67 名登革热患者进行了访谈。我们根据结局、场所和支付方对登革热发作的成本进行了细分。然后,我们计算了日惹和全国的总费用以及 95%置信区间(95%CI)。在医院、门诊、未就医和总体平均环境中,每例非重症登革热病例的费用分别为 316.24 美元(95%CI:242.30-390.18 美元)、22.45 美元(95%CI:14.12-30.77 美元)、7.48 美元(95%CI:2.36-12.60 美元)和 50.41 美元(95%CI:35.75-65.07 美元)。非重症病例的费用由患者家庭(37%)、社会捐助者(亲戚朋友,20%)、国家健康保险(25%)和其他来源(政府、慈善机构和私人保险,18%)承担。在包括重症病例后,每个病例的平均费用为 90.41 美元(95%CI:72.79-112.35 美元)。2017 年印度尼西亚估计有 753.5 万(95%CI:131.90-1651.30 万)例登革热病例,全国总费用为 6812.6 万美元(95%CI:2322.80-23715.60 万美元)。与仅检查正规医疗部门的大多数先前研究不同,本研究纳入了未就医的全国 63%的登革热病例。此外,本研究使用了实际费用,而不是收费,后者通常会低估公共设施中登革热的经济负担。总体而言,本研究发现印度尼西亚的登革热总费用比之前估计的高出 73%,这加强了有效控制的必要性。
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