Economic and epidemiological impact of dengue illness over 16 years from a public health system perspective in Brazil to inform future health policies including the adoption of a dengue vaccine

ABSTRACT

Introduction: Dengue is a serious global health problem endemic in Brazil. Consequently, our aim was to measure the costs and disease burden of symptomatic dengue infections in Brazil from the perspective of the Brazilian Public Health System (SUS) between 2000 and 2015, using Brazilian public health system databases. Specific age group incidence estimates were used to calculate the disability-adjusted life years (DALYs) to gain a better understanding of the disease burden.

Areas covered: SUS spent almost USD159 million and USD10 million to treat dengue and severe dengue, respectively, between 2000 and 2015. This is principally hospitalization costs, with the majority of patients self-treated at home with minor symptoms. The average notification rate for dengue was 273 per 100,000 inhabitants and three per 100,000 for severe dengue, with annual DALYs estimates ranging between 72.35 and 6,824.45 during the 16 years.

Expert commentary: The epidemiological and morbidity burden associated with dengue is substantial in Brazil, with costs affected by the fact that most patients self-treat at home with these costs not included in SUS. The Brazilian government urgently needs to proactively evaluate the real costs and clinical benefits of any potential dengue vaccination program by the National Immunization Program to guide future decision-making.

KEYWORDS:

• Burden of disease
• epidemiology
• economic
• dengue
• public health
• Brazil

Key issues

• A total of 702,270 and 29,925 individuals utilized SUS services to treat, respectively, dengue and severe dengue in Brazil, totalizing 739,177 hospitalizations and 4986 deaths associated with this infection in the country, between January 2000 and December 2015. This resulted in almost USD159 million and USD10 million spent by SUS to treat dengue and severe dengue, respectively, between January 2000 and December 2015.

• Annual DALYs estimates ranging between 42.64 and 6,824.45 over the study period associated with DENV in Brazil.

• The use of real-world numbers involving the hospitalization services within the Brazilian public health system (epidemiology and cost) combined with other economic analysis can contribute to discussions involving the possible incorporation of a dengue vaccine into the Brazilian National Immunization Program.

• The Brazilian government urgently needs to proactively evaluate the real costs and clinical benefits of any potential dengue vaccination program by the National Immunization Program to guide future decision-making.

Author contributions

I.P. Godói wrote the first draft; I.P. Godói, L.V.D. da Silva, A.R. Sarker, I. Megiddo and A. Morton helped undertake the study and the analysis; I. Godói, A. Morton, S. Alvarez-Madrazo, B. Godman, M. Bennie and A.A. Guerra Junior subsequently revised the draft and produced the final manuscript. All authors approved the final manuscript.

Acknowledgments

IPG received financial support from CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) (process number: 88881.134286/2016-01) by Doctoral Sandwich Program Abroad. The write-up was in part supported by a Newton Advanced Fellowship awarded to Professor Augusto Afonso Guerra Junior by the Academy of Medical Sciences, through the UK Government’s Newton Fund program.

Declaration of interest

I.P. Godói has previously received financial support from CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) (process number: 88881.134286/2016-01) by Doctoral Sandwich Program Abroad. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

The project was in part supported by a Newton Advanced Fellowship by the Academy of Medical Sciences to A. A. Gerrra Júnior through the UK Government’s Newton Fund program.