Costs of illness due to endemic cholera

Abstract

Summary Economic analyses of cholera immunization programmes require estimates of the costs of cholera. The Diseases of the Most Impoverished programme measured the public, provider, and patient costs of culture-confirmed cholera in four study sites with endemic cholera using a combination of hospital- and community-based studies. Families with culture-proven cases were surveyed at home 7 and 14 days after confirmation of illness. Public costs were measured at local health facilities using a micro-costing methodology. Hospital-based studies found that the costs of severe cholera were USD 32 and 47 in Matlab and Beira. Community-based studies in North Jakarta and Kolkata found that cholera cases cost between USD 28 and USD 206, depending on hospitalization. Patient costs of illness as a percentage of average monthly income were 21% and 65% for hospitalized cases in Kolkata and North Jakarta, respectively. This burden on families is not captured by studies that adopt a provider perspective.

Using private demand studies to calculate socially optimal vaccine subsidies in developing countries

“…as well as direct and indirect economic costs (lost wages for patient and caretaker, value of time away from school for children). Poulos et al (2008) found average private COI to be US$5.3 for cases in children and US$6.5 for adult cases. Because our model does not distinguish between adult and child cases, we use a weighted average of US$5.5 because incidence is six times higher in children .…”

“…Poulos et al (2008) found average public COI to be approximately US$15 for child cases and US$16 for adult cases. We use US$15 for our analysis.…”

Economics and financing of vaccines for diarrheal diseases

“…38 Several studies have evaluated the cost of cholera illness in developing countries. [40][41][42][43] Economic burden: high income country A MEDLNE search found no studies evaluating the economic burden of cholera in developed countries. .…”

“…42 A hospitalized case incurred a mean total cost ranging from $31.5 (Bangladesh) to $205.7 (Indonesia) for all ages and $36.0 to $223.0 for children <5 y (2005 $US); total outpatient costs of illness were $28.1 for all ages and $23.5 for children under 5 y in Indonesia. 42 This study prospectively followed cases (both community and hospital cases) and included extensive and comprehensive costs.…”

“…42 A hospitalized case incurred a mean total cost ranging from $31.5 (Bangladesh) to $205.7 (Indonesia) for all ages and $36.0 to $223.0 for children <5 y (2005 $US); total outpatient costs of illness were $28.1 for all ages and $23.5 for children under 5 y in Indonesia. 42 This study prospectively followed cases (both community and hospital cases) and included extensive and comprehensive costs. However, costs were obtained from questionnaires for post-cholera confirmed cases, which may induce recall bias; additionally cost for hospitalized cases came from a few facilities and offered a high level of care which may limit generalizability.…”