The socioeconomic impact of hepatitis E in Nepal.

Abstract

Abstract. Hepatitis E disease is responsible for substantial morbidity in Nepal. A socioeconomic analysis was performed to describe the costs and the effects of hepatitis E disease (HE) on health status in a Nepalese population living in the Kathmandu Valley. A modified health status index was used to quantify healthy days lost associated with HE. One hundred thirty-four individuals recently recovered from HE were interviewed in June 1998. The median age was 22 years and 60% were female. Study participants were sick and bedridden for a median of 22 and 10 days, respectively. The median healthy days lost per individual was 35 (768,000 total per region). The median cost of illness per individual, including direct and indirect, was $37 ($1,238,676 total per region). The percentage of yearly income lost for wage earners totaled 19.4%. Hepatitis E disease is associated with significant costs and loss of healthy days in Nepal. Further research is warranted to understand and limit this common disease.Viral hepatitis represents an important public health concern in Nepal, where hepatitis E virus (HEV) infection causes most of the hospitalized acute hepatitis disease in Kathmandu and the surrounding area.1,2 Hepatitis E disease (HE), formerly known as enterically transmitted non-A, non-B hepatitis, primarily afflicts populations in countries with poor environmental sanitation. 3,4 This disease is similar to hepatitis A disease (HA) with respect to transmission, clinical course, and absence of chronic disease. Hepatitis E disease attack rates are highest in young adults rather than in children as is the case with HA. 3,5,6 However, there can be greater morbidity associated with HE and the mortality rate of HE is higher than that found with HA in certain subsets of the population. 5 The incidence of fulminant hepatitis and the mortality rate for HE are highest among pregnant women in their third trimester. 3,6 Age-specific infection rates for persons 12-19 years of age have been estimated at 99/1,000 during sporadic transmission and higher during outbreaks.

The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study

“…The average total direct costs for HIV treatment in our study were higher than reported for tuberculosis, water borne diseases and malaria treatment in Nepal [31–33]. However, we cannot compare other studies in Nepal with costs of kala-azar (visceral leishmaniosis or VL) [8, 34], and hepatitis E treatment [35] because of methodological differences in calculation of the costs.…”

“…The findings of the studies on kala-azar (VL) [34, 39], hepatitis E [35] and malaria [33] could not be compared because of methodological differences in calculating days lost, since these studies calculated costs on a per episode basis.…”

Epidemiology and Risk Factors of Incident Hepatitis E Virus Infections in Rural Bangladesh

“…Although there is little evidence of common long-term sequelae of HEV genotype 1 infections, the fatality associated with hepatitis E in pregnancy and the economic burden of this disease require that resources be committed to improving our understanding of a virus that has been ''emerging'' for nearly 3 decades (1,41,42). Our data begin to shed light on the population burden of HEV in rural Bangladesh; considering its~150 million population,~70% of whom are rural inhabitants, it is important to recognize the true potential burden of hepatitis E, especially as the means to control this infection are within our grasp (43).…”

Epidemiology of Hepatitis E in Low- and Middle-Income Countries of Asia and Africa

“…The illness cost each individual an average of $37, which amounted to 19.4% of his or her yearly income. 22 In China, the average illness duration was almost 23 days and cost each patient an average of 10,655 RMB ($1673 USD). 23 Researchers estimated that the disease burden of a 2007 to 2009 epidemic of hepatitis E in Kitgum, Uganda amounted to 7,066 DALYs (disability adjusted life years).…”