Economic analysis of dengue prevention and case management in the Maldives

Abstract

As tourism is the mainstay of the Maldives’ economy, this country recognizes the importance of controlling mosquito-borne diseases in an environmentally responsible manner. This study sought to estimate the economic costs of dengue in this Small Island Developing State of 417,492 residents. The authors reviewed relevant available documents on dengue epidemiology and conducted site visits and interviews with public health offices, health centers, referral hospitals, health insurers, and drug distribution organizations. An average of 1,543 symptomatic dengue cases was reported annually from 2011 through 2016. Intensive waste and water management on a resort island cost $1.60 per occupied room night. Local vector control programs on inhabited islands cost $35.93 for waste collection and $7.89 for household visits by community health workers per person per year. Ambulatory care for a dengue episode cost $49.87 at a health center, while inpatient episodes averaged $127.74 at a health center, $1,164.78 at a regional hospital, and $1,655.50 at a tertiary referral hospital. Overall, the cost of dengue illness in the Maldives in 2015 was $2,495,747 (0.06% of gross national income, GNI, or $6.10 per resident) plus $1,338,141 (0.03% of GNI or $3.27 per resident) for dengue surveillance. With tourism generating annual income of $898 and tax revenues of $119 per resident, results of an international analysis suggest that the risk of dengue lowers the country’s gross annual income by $110 per resident (95% confidence interval $50 to $160) and its annual tax receipts by $14 per resident (95% confidence interval $7 to $22). Many innovative vector control efforts are affordable and could decrease future costs of dengue illness in the Maldives.

Islands as Hotspots for Emerging Mosquito-Borne Viruses: A One-Health Perspective

“…This partnership provides a long-term vision and action plan towards sustainable development on island states [162]. The Maldives are an example of a SIDS that is actively engaging in mosquito source reduction as well as disease management strategies including a dengue hotline to connect clinicians across this expansive archipelago with up-to-date advice [163]. An example of a community-based approach is exemplified by the PAHO, the Caribbean Public Health Agency (CARPHA) and the Caribbean Community’s (CARICOM) “Caribbean Mosquito Awareness Week”, an annual event to raise awareness about the connection between mosquitoes and the diseases they transmit and to work with the community to prevent mosquito breeding [164].…”

Spatial and temporal distribution of dengue in Brazil, 1990 - 2017

“…Several studies have demonstrated the economic and social impact on populations of endemic dengue areas [7][8][9][10], including economic impact in regions where the economy is based on tourism [11]. An estimate by Bhatt et al [1] indicates that dengue is responsible for about 390 million infections per year, of which 96 million are apparent cases (clinically manifest).…”

Economic burden of dengue illness in India from 2013 to 2016: A systematic analysis

“…In addition to health care costs, dengue may impact tourism, as estimated for the neighboring island country of the Maldives (Bangert et al, 2018) and, at least conceptually, could affect development more broadly (Castro et al, 2017). Although uncertainty intervals remains wide, these latest estimates reinforce the health and economic benefits that India would realize if dengue were substantially controlled.…”