The economic burden of pediatric gastroenteritis to Bolivian families: a cross-sectional study of correlates of catastrophic cost and overall cost burden

Abstract

BackgroundWorldwide, acute gastroenteritis causes substantial morbidity and mortality in children less than five years of age. In Bolivia, which has one of the lower GDPs in South America, 16% of child deaths can be attributed to diarrhea, and the costs associated with diarrhea can weigh heavily on patient families. To address this need, the study goal was to identify predictors of cost burden (diarrhea-related costs incurred as a percentage of annual income) and catastrophic cost (cost burden ≥ 1% of annual household income).MethodsFrom 2007 to 2009, researchers interviewed caregivers (n = 1,107) of pediatric patients (<5 years old) seeking treatment for diarrhea in six Bolivian hospitals. Caregivers were surveyed on demographics, clinical symptoms, direct (e.g. medication, consult fees), and indirect (e.g. lost wages) costs. Multivariate regression models (n = 551) were used to assess relationships of covariates to the outcomes of cost burden (linear model) and catastrophic cost (logistic model).ResultsWe determined that cost burden and catastrophic cost shared the same significant (p < 0.05) predictors. In the logistic model that also controlled for child sex, child age, household size, rural residence, transportations taken to the current visit, whether the child presented with complications, and whether this was the child’s first episode of diarrhea, significant predictors of catastrophic cost included outpatient status (OR 0.16, 95% CI [0.07, 0.37]); seeking care at a private hospital (OR 4.12, 95% CI [2.30, 7.41]); having previously sought treatment for this diarrheal episode (OR 3.92, 95% CI [1.64, 9.35]); and the number of days the child had diarrhea prior to the current visit (OR 1.14, 95% CI [1.05, 1.24]).ConclusionsOur analysis highlights the economic impact of pediatric diarrhea from the familial perspective and provides insight into potential areas of intervention to reduce associated economic burden.

Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates

“…Studies identified for quantitative analysis in the systematic review (N = 25) represented six low-income countries (LIC) [16,[28][29][30][31][32], nine lower-middle-income countries (LMIC) [18,19,30,[33][34][35][36][37][38][39][40][41][42][43][44], and five uppermiddle-income countries (UMIC) [13,17,[45][46][47], as classified by the World Bank's income groups in 2018 [25]. While most studies reported using societal perspective (22/25, 88%) in measuring cost [13, 17-19, 29-32, 34-37, 39, 41-49], we observed a wide variation in use of term societal perspective across those studies.…”

“…In Bolivia, the two publications from the same group of authors [18,44], which use the same data source but with separate sub-group analyses reveal variations in direct costs across private versus public facilities and across urban and rural areas. Both direct medical and nonmedical costs for outpatient care in rural settings were much higher than for inpatient care.…”

Global Economic Burden of Norovirus Gastroenteritis

“…These productivity losses likely represent a large portion of a household’s income in LMICs. For example, productivity losses accounted for 73% of spending for rotavirus in Malaysia and households with the lowest income are more likely to experience catastrophic payments than those with the highest income[ 44 ]; in Bolivia, indirect costs equate to 3 to 4 days of income[ 45 ] and in Kenya direct and indirect costs represent a large part of a households monthly income[ 46 ].…”

Household Costs of Diarrhea by Etiology in 7 Countries, The Global Enterics Mulitcenter Study (GEMS)

“…Additional studies have examined various aspects of the costs of diarrheal disease, as in Colombia [9], Libya [10], Vietnam [11, 12], India [13–16], Rwanda [17], Kenya [18], China [19], Tunisia [20], and Kazakhstan [21]. Costs studies have also focused on the impacts of differing aspects of care [22, 23] or impacts on family budgets [24]. Finally, many costs studies have evaluated the costs of diarrheal disease in the context of cost-effectiveness of a rotavirus vaccine [25–28] or other interventions [29].…”