Economic burden and associated factors of measles patients in Zhejiang Province, China

Deng, Xuan; He, Hanqing; Zhou, Yang; Xie, Shuyun; Fang, Ya; Zeng, Yanbing; Yan, Rui; Tang, Xuewen; Fu, Jing

doi:10.1080/21645515.2019.1599673

Cited by 14 publications

(8 citation statements)

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“…The influence of age on economic burden may be biased by vaccination. Previous studies [47][48] indicated that patients with insurance are likely to have clinical overtreatment and unnecessary use of expensive antiviral drugs, which is comparable to our study and leads to higher direct medical cost.…”

Section: Discussionsupporting

confidence: 85%

Economic and disease burden of Japanese encephalitis in Zhejiang Province, 2013–2018

Deng

Yan

et al. 2021

PLoS Negl Trop Dis

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Background Japanese encephalitis (JE) is a mosquito-borne disease and associated with high mortality and disability rate among symptomatic cases. In the absence of local data, this study estimated the economic burden and the disability-adjusted life years (DALYs) due to JE in Zhejiang Province, China during 2013–2018, to increase disease awareness and provide evidence for effective health policy. Methodology/Principle findings We merged multiple data sources, including National Notifiable Disease Registry System (NNDRS), patient interviews and medical records from corresponding hospitals for JE cases which occurred during 2013–2018 in Zhejiang Province. Direct costs were extracted from hospitals’ billing systems and patient interviews. Indirect costs and disease burden were calculated based on questionnaire survey from patient interviews and follow-up assessment by general practitioners. Given under-reporting, an expansion factor (EF) was applied to extrapolate the JE burden to the provincial level. The total economic burden of JE during 2013–2018 was estimated at US $12.01 million with an EF = 3. Of this, $8.32 million was due to direct economic cost and $3.69 million to indirect cost. The disease burden of JE was 42.75 DALYs per million population (28.44 YLD, 14.28 YLL) according to the 1990 Global Burden of Disease (GBD 1990) methodology and 80.01 DALYs (53.67YLD, 26.34YLL) according to the GBD 2010 methodology. Sensitivity analysis demonstrated that the overall economic burden varied from US$ 1.73–36.42 million. The greatest variation was due to the prognosis of illness (-85.57%-203.17%), followed by occupation (-34.07%-134.12%) and age (-72.97%-47.69%). Conclusions/Significance JE imposes a heavy burden for families and society in Zhejiang Province. This study provides comprehensive empirical estimates of JE burden to increase awareness and strengthen knowledge of the public. These data may support provincial level public health decision making for prevention and control of JE. Ongoing surveillance for acute meningitis and encephalitis syndrome (AEMS) in sentinel hospitals, is needed to further refine estimates of JE burden.

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Section: Discussionsupporting

confidence: 85%

Economic and disease burden of Japanese encephalitis in Zhejiang Province, 2013–2018

Deng

Yan

et al. 2021

PLoS Negl Trop Dis

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“…WHO guidelines for the elimination of measles suggest that large-scale outbreaks of measles can be avoided if the MCV coverage is more than 90% in the whole population and that at least 95% coverage could eliminate measles entirely ( 26 ). The Chinese government launched the National Expanded Program on Immunization (EPI) in 2007 that vaccinated with the MCV at 8 and 18 months of age ( 27 ). With these efforts, the measles incidence in China decreased dramatically, from 99.4 per million in 2008 when 151 cases were reported in the Zhoushan Islands ( Figure 1A ) to 4.6 in 2012 when two cases were reported in the Zhoushan Islands ( Figure 1A ) ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Epidemiological Investigation and Virus Tracing of a Measles Outbreak in Zhoushan Islands, China, 2019

Zhang

Chen

Tang

et al. 2020

Front. Public Health

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Background: Measles transmissions due to case importations challenge public health systems globally and herd immunities in all countries. In 2019, an imported measles case and its subsequently outbreak was found in the Zhoushan Islands. Here, the process of epidemiological investigation and virus tracing were summarized to provide references for the prevention and control of measles in the future.Materials and methods: The data on the demographic, epidemiological, and clinical manifestation of measles cases in this outbreak were collected. The 450 bp fragments of the measles virus (MeV) N gene were amplified and sequenced. The genome of the first imported case was further isolated. Then, the maximum-likelihood and time-scaled phylogenetic analysis was conducted.Results: A total of 28 measles cases were confirmed. Their onsets were between March 13 and May 18, 2019. The first patient was from the Ukraine. He was confirmed at the Fever Clinic in Zhoushan hospital on March 15, 2019 and at the same time, another patient had visited the hospital due to another illness and 10 days later, this second case had onset (March 25, 2019). The epidemic curve shows sustained community transmission. The majority of the following cases (19/26) were clustered on the Donggang street which was close to where the second case worked. The 22 measles virus strains successfully isolated from this outbreak all belonged to the D8.2a sub-cluster and clustered with the KY120864/MVs/GirSomnath.IND/42.16/[D8] which was the predominant genotype in the Ukraine during 2018-2019. The analysis of the complete D8 genotype genome pointed to the fact that this prevailing strain originated from India in 2015 and its substitution rate was estimated as 6.91 × 10−4 (5.64–7.98 × 10−4) nucleotide substitutions/site/year.Conclusion: This outbreak was caused by an imported case from the Ukraine. There was a possible nosocomial infection between the first case and the second case. Then, the second case played an important role in the spread of virus due to her occupation. The molecular phylogenetic analysis could help to track the origin of the virus. Increasing and maintaining the high level of vaccination coverage (≥95%) and an efficient response to imported cases are essential to prevent and control the recurrence and outbreak of measles virus.

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“…However, with declining stockpiles (yellow fever), the discovery of gaps in immunity in young adults (rubella) [8] and a sharp recrudescence of cases (measles), strategies to sustain and improve the coverage of these existing vaccines are at the forefront, potentially delaying the introduction of vaccines against other diseases. To our knowledge, there is no other empirical cost-of-illness study for measles in lowincome settings: only a few were done in lower-and uppermiddle-income countries [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

The economic burden of measles in children under five in Bangladesh

Broucker

Ahmed

Hasan

et al. 2020

BMC Health Serv Res

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Background This study estimated the economic cost of treating measles in children under-5 in Bangladesh from the caregiver, government, and societal perspectives. Method We conducted an incidence-based study using an ingredient-based approach. We surveyed the administrative staff and the healthcare professionals at the facilities, recording their estimates supported by administrative data from the healthcare perspective. We conducted 100 face-to-face caregiver interviews at discharge and phone interviews 7 to 14 days post-discharge to capture all expenses, including time costs related to measles. All costs are in 2018 USD ($). Results From a societal perspective, a hospitalized and ambulatory case of measles cost $159 and $18, respectively. On average, the government spent $22 per hospitalized case of measles. At the same time, caregivers incurred $131 and $182 in economic costs, including $48 and $83 in out-of-pocket expenses in public and private not-for-profit facilities, respectively. Seventy-eight percent of the poorest caregivers faced catastrophic health expenditures compared to 21% of the richest. In 2018, 2263 cases of measles were confirmed, totaling $348,073 in economic costs to Bangladeshi society, with $121,842 in out-of-pocket payments for households. Conclusion The resurgence of measles outbreaks is a substantial cost for society, requiring significant short-term public expenditures, putting households into a precarious financial situation. Improving vaccination coverage in areas where it is deficient (Sylhet division in our study) would likely alleviate most of this burden.

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Economic burden and associated factors of measles patients in Zhejiang Province, China

Cited by 14 publications

References 20 publications

Economic and disease burden of Japanese encephalitis in Zhejiang Province, 2013–2018

Economic and disease burden of Japanese encephalitis in Zhejiang Province, 2013–2018

Epidemiological Investigation and Virus Tracing of a Measles Outbreak in Zhoushan Islands, China, 2019

The economic burden of measles in children under five in Bangladesh

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