Abstract
Dengue presents a formidable and growing global economic and disease burden, with around half the world's population estimated to be at risk of infection. There is wide variation and substantial uncertainty in current estimates of dengue disease burden and, consequently, on economic burden estimates. Dengue disease varies across time, geography and persons affected. Variations in the transmission of four different viruses and interactions among vector density and host's immune status, age, pre-existing medical conditions, all contribute to the disease's complexity. This systematic review aims to identify and examine estimates of dengue disease burden and costs, discuss major sources of uncertainty, and suggest next steps to improve estimates. Economic analysis of dengue is mainly concerned with costs of illness, particularly in estimating total episodes of symptomatic dengue. However, national dengue disease reporting systems show a great diversity in design and implementation, hindering accurate global estimates of dengue episodes and country comparisons. A combination of immediate, short-, and long-term strategies could substantially improve estimates of disease and, consequently, of economic burden of dengue. Suggestions for immediate implementation include refining analysis of currently available data to adjust reported episodes and expanding data collection in empirical studies, such as documenting the number of ambulatory visits before and after hospitalization and including breakdowns by age. Short-term recommendations include merging multiple data sources, such as cohort and surveillance data to evaluate the accuracy of reporting rates (by health sector, treatment, severity, etc.), and using covariates to extrapolate dengue incidence to locations with no or limited reporting. Long-term efforts aim at strengthening capacity to document dengue transmission using serological methods to systematically analyze and relate to epidemiologic data. As promising tools for diagnosis, vaccination, vector control, and treatment are being developed, these recommended steps should improve objective, systematic measures of dengue burden to strengthen health policy decisions.
Highlights
Dengue presents a formidable global economic and disease burden with around half the world’s population estimated to be at risk of infection [1,2]
Economic burden has three main components: (i) costs of illness, estimated from the total symptomatic episodes multiplied by the average costs per episode [9,10], (ii) costs of dengue prevention, surveillance, and control strategies [11,12], and (iii) other impacts of dengue, usually harder to estimate, such as effects of dengue outbreaks on tourism [13], co-morbidities and complications associated with dengue virus (DENV) infection [14,15,16], or the effects of the seasonal clustering of dengue on health systems [17]
Dengue burden data and sources of variability Estimates of the disease and economic burden of dengue were derived by combining surveillance, clinical, and cost data
Summary
Dengue presents a formidable global economic and disease burden with around half the world’s population estimated to be at risk of infection [1,2]. Dengue disease varies across time and age of persons affected. This complexity results from the transmission of four different viruses affected by vector density, the host’s immune status, age, pre-existing medical conditions and other factors [5,6]. Accurate estimates of the economic and disease burden of dengue are critical to track health progress, assess program impact and results, and inform decisions about health policy, research, and health service priorities [7,18,19,20]. Estimates of dengue burden have substantial variability due to limitations in the availability, quality, and use of data
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