Typhoid and Paratyphoid Cost of Illness in Bangladesh: Patient and Health Facility Costs From the Surveillance for Enteric Fever in Asia Project II

Abstract

Background We conducted a cost of illness study to assess the economic burden of pediatric enteric fever (typhoid and paratyphoid) in Bangladesh. Results can inform public health policies to prevent enteric fever. Methods The study was conducted at 2 pediatric health facilities in Dhaka. For the patient and caregiver’s perspective, we administered questionnaires on costs incurred from illness onset until the survey dates to caregivers of patients with blood culture positive cases at enrollment and 6 weeks later to estimate the direct medical, direct nonmedical, and indirect costs. From the perspective of the health care provider, we collected data on quantities and prices of resources used by the 2 hospitals to estimate the direct medical economic costs to treat a case of enteric fever. We collected costs in Bangladeshi takas and converted them into 2018 US dollars. We multiplied the unit cost per procedure by the frequency of procedures in the surveillance case cohort to calculate the average cost per case. Results Among the 1772 patients from whom we collected information, the median cost of illness per case of enteric fever from the patient and caregiver perspective was US $64.03 (IQR: US $33.90 –$173.48). Median direct medical and nonmedical costs per case were 3% of annual labor income across the sample. From the perspective of the healthcare provider, the average direct medical cost per case was US $58.64 (range: US $37.25 at Hospital B, US $73.27 at Hospital A). Conclusions Our results show substantial economic burden of enteric fever in Bangladesh, with higher costs for patients receiving inpatient care. As antimicrobial resistance increases globally, the cost of illness could increase, due to more expensive and potent drugs required for treatment.

Incidence of typhoid and paratyphoid fever in Bangladesh, Nepal, and Pakistan: results of the Surveillance for Enteric Fever in Asia Project

“…The high rates of hospitalisation indicate considerable morbidity and economic impact, highlighting the need for control measures, including the implementation of TCV. 24 , 25 , 26 …”

Acute febrile illness among outpatients seeking health care in Bangladeshi hospitals prior to the COVID-19 pandemic

“…In contrast to many studies focusing on a single pathogen [21,22,24,25,31,33,37,[50][51][52][53][54][55][56][57][58][59][60][61][62][63], this surveillance tested for multiple pathogens causing acute febrile illness in Bangladesh. Our findings extended the work of Labib et al (2017), where the researchers tested multiple pathogens among hospital-based febrile patients, both inpatient and outpatient, from December 2008 to November 2009 in Bangladesh [5].…”

“…They reported Rickettsia (37%) and dengue (9.6%) as the predominant causes of AFI in their study, along with very few cases of Coxiella, Leptospira, Bartonella, and chikungunya virus infections. Other than malaria in endemic zones, most single pathogen studies of acute febrile illness investigated enteric fever [21][22][23][24][25][26][27][28] and dengue [29][30][31][32][33][34][35][36][37] as these are common diseases in Bangladesh.…”

Typhoid in Bangladesh: Challenges, efforts, and recommendations

“…From the healthcare provider perspective, the average cost was US$58.64. Median direct and medical and nonmedical costs per case were 3% of annual labour income [ 27 ].…”

“…A relief can be provided to the patients suffering from this enteric disease if the government invests in new diagnostic laboratories. Such Laboratories which can do blood culture confirmation can save a lot of money that would otherwise been spent on the misdiagnosed disease [ 27 ]. Apart from this the government should also invest on telemedicine.…”