Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Department of Pathology, School of Medical Sciences, Sydney, NSW, Australia.
PLoS One. 2021 Oct 8;16(10):e0258388. doi: 10.1371/journal.pone.0258388. eCollection 2021.
The cost in managing hospitalised dengue patients varies across countries depending on access to healthcare, management guidelines, and state sponsored subsidies. For health budget planning, locally relevant, accurate costing data from prospective studies, is essential.
To characterise the direct costs of managing hospitalised patients with suspected dengue infection in Sri Lanka.
Colombo Dengue Study is a prospective single centre cohort study in Sri Lanka recruiting suspected hospitalised dengue fever patients in the first three days of fever and following them up until discharge. The diagnosis of dengue is retrospectively confirmed and the cohort therefore has a group of non-dengue fever patients with a phenotypically similar illness, managed as dengue while in hospital. The direct costs of hospital admission (base and investigation costs, excluding medication) were calculated for all recruited patients and compared between dengue and non-dengue categories as well as across subgroups (demographic, clinical or temporal) within each of these categories. We also explored if excluding dengue upfront, would lead to an overall cost saving in several hypothetical scenarios.
From October 2017 to February 2020, 431 adult dengue patients and 256 non-dengue fever patients were recruited. The hospitalisation costs were USD 18.02 (SD: 4.42) and USD 17.55 (SD: 4.09) per patient per day for dengue and non-dengue patients respectively (p>0.05). Laboratory investigations (haematological, biochemical and imaging) accounted for more than 50% of the total cost. The costs were largely homogenous in all subgroups within or across dengue and non-dengue categories. Excluding dengue upfront by subsidised viral genomic testing may yield overall cost savings for non-dengue patients.
As non-dengue patients incur a similar cost per day as the dengue patients, confirming dengue diagnosis using subsidised tests for patients presenting in the first three days of fever may be cost-efficient.
管理住院登革热患者的成本因国家获得医疗保健的途径、管理指南和国家补贴的不同而有所差异。对于卫生预算规划，从前瞻性研究中获取当地相关的准确成本数据至关重要。
描述斯里兰卡住院疑似登革热感染患者的直接管理成本。
科伦坡登革热研究是斯里兰卡的一项前瞻性单中心队列研究，在发热的前三天内招募疑似住院的登革热患者，并对其进行随访直至出院。登革热的诊断是回顾性确认的，因此该队列中有一组非登革热发热患者，他们在住院期间的表现与登革热相似，按登革热进行管理。计算了所有入组患者的住院直接费用（基础和检查费用，不包括药物），并比较了登革热和非登革热组之间以及这些组内的亚组（人口统计学、临床或时间）之间的差异。我们还探讨了在几种假设情况下，是否可以预先排除登革热，从而节省整体费用。
从 2017 年 10 月至 2020 年 2 月，共招募了 431 名成年登革热患者和 256 名非登革热发热患者。登革热和非登革热患者的住院费用分别为每天 18.02 美元（SD：4.42）和 17.55 美元（SD：4.09）（p>0.05）。实验室检查（血液学、生化和影像学）占总费用的 50%以上。在登革热和非登革热组内或组间的所有亚组中，费用基本一致。通过补贴性病毒基因组检测预先排除登革热可能会为非登革热患者带来总体成本节省。
由于非登革热患者每天的费用与登革热患者相似，因此对于在发热的前三天内就诊的患者，使用补贴性检测来确认登革热诊断可能具有成本效益。
