Cost of Nine Pediatric Infectious Illnesses in Low- and Middle-Income Countries: A Systematic Review of Cost-of-Illness Studies

Abstract

Background Cost-of-illness data from empirical studies provide insights into the use of healthcare resources including both expenditures and the opportunity cost related to receiving treatment. Objective The objective of this systematic review was to gather cost data and relevant parameters for hepatitis B, pneumonia, meningitis, encephalitis caused by Japanese encephalitis, rubella, yellow fever, measles, influenza, and acute gastroenteritis in children in low- and middle-income countries. Data Sources Peer-reviewed studies published in public health, medical, and economic journals indexed in PubMed (MEDLINE), Embase, and EconLit. Study Eligibility Criteria, Participants, and Interventions Studies must (1) be peer reviewed, (2) be published in 2000–2016, (3) provide cost data for one of the nine diseases in children aged under 5 years in low- and middle-income countries, and (4) generated from primary data collection. Limitations We cannot exclude missing a few articles in our review. Measures were taken to reduce this risk. Several articles published since 2016 are omitted from the systematic review results, these articles are included in the discussion. Conclusions and Implications of Key Findings The review yielded 37 articles and 267 sets of cost estimates. We found no cost-of-illness studies with cost estimates for hepatitis B, measles, rubella, or yellow fever from primary data. Most estimates were from countries in Gavi preparatory (28%) and accelerated (28%) transition, followed by those who are initiating self-financing (22%) and those not eligible for Gavi support (19%). Thirteen articles compared household expenses to manage illnesses with income and two articles with other household expenses, such as food, clothing, and rent. An episode of illness represented 1–75% of the household’s monthly income or 10–83% of its monthly expenses. Articles that presented both household and government perspectives showed that most often governments incurred greater costs than households, including non-medical and indirect costs, across countries of all income statuses, with a few notable exceptions. Although limited for low- and middle-income country settings, cost estimates generated from primary data collection provided a ‘real-world’ estimate of the economic burden of vaccine-preventable diseases. Additional information on whether common situations preventing the application of official clinical guidelines (such as medication stock-outs) occurred would help reveal deficiencies in the health system. Improving the availability of cost-of-illness evidence can inform the public policy agenda about healthcare priorities and can help to operationalize the healthcare budget in local health systems to respond adequately to the burden of illness in the community.

Return On Investment From Immunization Against 10 Pathogens In 94 Low- And Middle-Income Countries, 2011–30

“…[28][29][30][31][32][33] Additional medication diagnostic costs were conservatively estimated to be 25-50 percent of the facility fees. 34 Transportation costs were estimated by multiplying the cost per round trip to a health care facility 35 by the number of care-seeking cases and visits per case. We assumed that caregivers would have the lowest opportunity cost of time to take children to a health facility for vaccination, so we used minimum wage 36,37 to estimate their productivity loss.…”

“…Ranges and distributions were based on the modelwide distribution of point estimates, with additional data for trans-portation and treatment costs extracted from a systematic review. 34 Uncertainty ranges for cases and deaths were derived from a Vaccine Impact Modelling Consortium publication. 25 A Monte Carlo simulation was performed with ten thousand bootstrap replications to construct a 95 percent uncertainty range.…”

The economic burden of pneumonia in children under five in Uganda

“…While the cost-effectiveness of PCV from a government perspective has been evaluated [9] , our understanding of its broader economic impact in low- and middle-income countries (LMIC) is limited. The existing literature focuses mostly on public sector protocols, often in tertiary-level facilities, and may not capture the impact that the disease has on caregivers and their households [5] , [10] . A significant number of caregivers pay for healthcare sought at private facilities, including both for-profit institutions and not-for-profit hospitals funded by charitable organizations and public subsidies [11] .…”

Hospitalization costs of coronaviruses diseases in upper-middle-income countries: A systematic review

“…The implementation of this exclusion criteria was based on the previous SR of economic burden. The reports discussed that although this study design may present primary cost evaluation, the proportion of studies that effectively are not based on secondary sources does not impact in the review results [30]. That said, the importance of this limitation for the overall interpretation of our SR is expected to be minor.…”