Cost Burden of Dengue Fever in a Rural Ramanagara District of Karnataka State

Abstract

Introduction Dengue fever is an arboviral disease caused by dengue virus, which is a single-stranded RNA virus and belongs to family Flaviviridae. Dengue fever (DF) has emerged as a global public health problem in recent years. The problem has become hyperendemic in many urban, peri-urban and rural areas, with frequent epidemics South-East Asia is one of the regions with highest risk of DF and accounts for 52% of the worldwide risk. In India, according to World Health Organization, 70.8% of the total health care expenditure was out-of-pocket in 2010. According to the World Bank, the percentage of out-of-pocket expenditure is as high as 86.4%. Dengue fever causes a significant economic and social burden on the population of endemic areas. This study was conducted with the objective to estimate the direct and indirect cost expenditure on families of dengue affected members and to assess the financial coping mechanisms of the families. Materials and methods Confirmed cases of DF with either NS-1 positive or IgM positive or positive for both and willing to participate in the study formed the sample. After taking informed consent, study subjects were interviewed using a pretested, semi-structured questionnaire. Questionnaire included demo- graphic profile and questions related to their financial coping mechanisms. Information on the laboratory bill, hospital bill, and pharmacy bill was collected from the hospital records on the day of patient's discharge. Indirect cost, such as travel expenses, food, and beverage expenses were collected from the family members of dengue patients. Necessary permission was taken from the hospital and RajaRajeswari Medical College & Hospital, Bengaluru, Karnataka, India. Data were collected and compiled in the MS excel sheet and were analyzed using Statistical Package for the Social Sciences version 20.0. Descriptive statistics-qualitative variables were presented as frequencies and percentages, continuous variables, such as hospital stay and cost are expressed in terms of mean and standard deviation. Results Average direct cost per household for treatment of dengue was 5185.395 INR. Average out-of-pocket expenditure per household for treatment of dengue was 6190 INR. Most of the households used savings as a mechanism to cope up with the increased expenditure due to dengue. About 77.6% of the households diverted their savings to pay for the treatment of dengue, 18.4% of households borrowed money from friends and relatives to pay the hospital bills, and the remaining 3% respondents used their health insurance as a financial coping mechanism to get the treatment for dengue. Conclusion There is a substantial financial loss to the Indian families of which a significant proportion lies below the poverty line. Government is the only agency working for the prevention of this kind of vector-borne disease. Public awareness in the community about the treatment of dengue is very scant. People use their savings which is the major method to cope up with expenditure due to DF. Significant proportion of the population uses the incurred borrowing as a method to pay for the treatment of dengue, which is a matter of concern. How to cite this article Kumar N, Shyam AC, Vidya. Cost Burden of Dengue Fever in a Rural Ramanagara District of Karnataka State. J Med Sci 2016;2(4):59-61.

Economic burden estimation associated with dengue and chikungunya in Gujarat, India

“…The total medical cost of dengue and chikungunya patients in the present study was higher than that reported in the earlier study from Surat[ 31 ] which was USD 14.8 (IQR 7.3–65.9)/INR (IQR 465–4194) and the average cost was USD (86.9 ± 170.7)/INR (5530 ± 10837). Another study from Surat[ 29 ] reported a direct medical cost of USD 439.44/INR 20407 which was similar to our study.…”

“…The total indirect cost of dengue and chikungunya patients in the present study was higher than that reported in the earlier study from Surat[ 29 ] which was USD 146.13/INR 6786. In other studies, the average indirect cost per household for treatment of dengue reported from Karnataka was INR 1540.65,[ 31 ] Haryana was INR 1840,[ 32 ] and from Vietnam was USD 28.7/INR 1693[ 41 ] which was less than our present study. The total direct and indirect cost of dengue and chikungunya patients was higher than the earlier reported study from Karnataka (INR 11278),[ 31 ] Haryana (INR 11563),[ 32 ] and Vietnam (USD 61.3/INR 3720).…”

“…Another study from Surat[ 29 ] reported a direct medical cost of USD 439.44/INR 20407 which was similar to our study. In other studies, the average direct cost per household for treatment of dengue reported from Karnataka was INR 9484,[ 31 ] Haryana was INR 10022.85,[ 32 ] Vietnam was USD 32.7 (INR 2027),[ 41 ] Cambodia was USD32 (INR 1887),[ 25 ] and Bangkok was USD 102 (INR 6364)[ 42 ] which was less than our present study.…”

“…Earlier studies on costs of dengue in Surat, 2010,[ 29 ] Karnataka, 2016[ 31 ] and Haryana, 2014[ 32 ] included direct and indirect costs, but only a few factors were included in calculating the direct and indirect costs in those studyies. In other studies, conducted in Surat, 2017[ 33 ] only direct cost was included and there was no information on non-medical costs such as food and transportation and exact indirect costs such as wage loss to patients and relatives.…”

Assessment of direct medical cost using cost of illness analysis in patients with dengue fever - Retrospective study

“…The findings were similar to the study conducted by Kumar N et al, in the rural district of Karnataka & found that 77.6% of households used their savings to pay for dengue care, 18.4% borrowed money from friends and family to pay for hospital bills, and the remaining 3% used their health insurance as a financial tool. 15…”