Impact of a Nonfatal Dengue Episode on Disability-Adjusted Life Years: A Systematic Analysis

Abstract

Abstract.As dengue causes about 4,000 symptomatic nonfatal episodes for every dengue death globally, quantitative disability assessments are critical to assess the burden of dengue and the cost-effectiveness of dengue control interventions. This systematic analysis of disability or quality of life lost from a symptomatic nonfatal dengue episode combined a systematic literature review, statistical modeling, and probabilistic sensitivity analyses. We conceptualized a dengue episode as having two phases: acute and persistent symptoms. Our estimates for the acute phase, consisting of onset and recovery periods and defined as the first 20 days (0.054 year), were based on literature review. We searched PubMed, POPLINE, EconLit, Google Scholar, scientific conferences, and other sources, for “dengue” plus “quality of life” or related terms. From 4,322 initial entries, six met our criteria (original studies with empirical data). The median disability-adjusted life year (DALY) burden for the acute phase was 0.011 (95% certainty interval [CI]: 0.006–0.015) for ambulatory episodes, 0.015 (CI: 0.010–0.020) for hospitalized episodes, and 0.012 (CI: 0.006–0.019) overall. Using literature reviews about persistent dengue, we estimated that 34% of episodes experienced persistent symptoms with a median duration of symptoms of 0.087 (CI: 0.040–0.359) year, which resulted in median DALYs of 0.019 (CI: 0.008–0.082). Thus, the overall median DALY burden was 0.031 (CI: 0.017–0.092) for ambulatory episodes, 0.035 (CI: 0.024–0.096) for hospitalized episodes, and 0.032 (CI: 0.018–0.093) overall. Our dengue-specific burden of a dengue episode was 2.1 times the 2013 Global Burden of Disease estimate. These literature-based estimates provide an empirical summary for policy and cost-effectiveness analyses.

Measuring health related quality of life for dengue patients in Iquitos, Peru

“…Another way to assess the impact of dengue on HRQoL is through the estimation of a disease burden metric such as DALYs. Using empirical data from 6 studies, Zeng et al, estimated that the first 20 days of a single episode of dengue are responsible for the loss of 0.012 years of healthy life [14]. Although the prediction of HRQoL scores was not the primary purpose of our multiple regression analysis using our model-predicted scores for males of the median age (16yrs) we calculated estimated DALYs for the first 20 days of a dengue episode for clinic, community and contact-cluster recruited participants.…”

“…The values can in turn be used to estimate disability adjusted life years (DALYs), a measure of the years of healthy life lost due to a certain illness in a given population [13]. A recent systematic analysis by Zeng et al used empirical data from 6 studies to estimate the disease burden of a single, nonfatal dengue episode [14]. The authors concluded that previous measures may have underestimated the disease burden of non-fatal dengue with the average episode of dengue being responsible for the loss of 0.032 years of healthy life [3].…”

“…The authors concluded that previous measures may have underestimated the disease burden of non-fatal dengue with the average episode of dengue being responsible for the loss of 0.032 years of healthy life [3]. As these studies only recruited individuals who actively sought treatment, individuals with less severe symptoms and those who cannot access health facilities were excluded, an important limitation [9,14].…”

The Uncertainty Surrounding the Burden of Post-acute Consequences of Dengue Infection

“…Other symptoms also reported include vomiting, diarrhoea, nausea, chills, and poor appetite [4]. Both hospitalized patients and outpatients can experience these post-acute consequences and they have not been shown to associate with the severity of the acute episode [4,8]. Furthermore, postacute consequences were usually associated with female gender and older age [3,4,9].…”

“…Abbreviations: YLDs: years of healthy life lost due to disability, YLLs: years of life lost due to premature death. of patients experiencing any fatigue or trouble working after recovery from dengue [6,8]. It was noteworthy that the time that the majority of studies followed up patients was short.…”