Economic and disease burden of Japanese encephalitis in Zhejiang Province, 2013-2018.

Xuan Deng,Zi-Qiao Li,Yang Zhou,Rui Yan,Hanqing He,Xue-Wen Tang,Michael Benjamin Arndt

doi:10.1371/journal.pntd.0009505

Abstract

BackgroundJapanese encephalitis (JE) is a mosquito-borne disease and associated with high mortality and disability rate among symptomatic cases. In the absence of local data, this study estimated the economic burden and the disability-adjusted life years (DALYs) due to JE in Zhejiang Province, China during 2013–2018, to increase disease awareness and provide evidence for effective health policy.Methodology/Principle findingsWe merged multiple data sources, including National Notifiable Disease Registry System (NNDRS), patient interviews and medical records from corresponding hospitals for JE cases which occurred during 2013–2018 in Zhejiang Province. Direct costs were extracted from hospitals’ billing systems and patient interviews. Indirect costs and disease burden were calculated based on questionnaire survey from patient interviews and follow-up assessment by general practitioners. Given under-reporting, an expansion factor (EF) was applied to extrapolate the JE burden to the provincial level. The total economic burden of JE during 2013–2018 was estimated at US $12.01 million with an EF = 3. Of this, $8.32 million was due to direct economic cost and $3.69 million to indirect cost. The disease burden of JE was 42.75 DALYs per million population (28.44 YLD, 14.28 YLL) according to the 1990 Global Burden of Disease (GBD 1990) methodology and 80.01 DALYs (53.67YLD, 26.34YLL) according to the GBD 2010 methodology. Sensitivity analysis demonstrated that the overall economic burden varied from US$ 1.73–36.42 million. The greatest variation was due to the prognosis of illness (-85.57%-203.17%), followed by occupation (-34.07%-134.12%) and age (-72.97%-47.69%).Conclusions/SignificanceJE imposes a heavy burden for families and society in Zhejiang Province. This study provides comprehensive empirical estimates of JE burden to increase awareness and strengthen knowledge of the public. These data may support provincial level public health decision making for prevention and control of JE. Ongoing surveillance for acute meningitis and encephalitis syndrome (AEMS) in sentinel hospitals, is needed to further refine estimates of JE burden.

Highlights

Japanese encephalitis (JE), caused by Japanese encephalitis virus (JEV), is one of the most serious vector-borne viral encephalitis infections in Southeast Asia, the Western Pacific Region, and Northern Australia [1,2]
Between September 2018 and April 2019, 61 laboratory-confirmed JE cases were available to be interviewed for the retrospective disease history, of whom 60 were valid for analysis and one case withdrew during the interview (S1 Table)
Other estimates of economic cost per case in the region include Bali [34] (Indonesia, 2001–2002, direct medical cost: $311-$2124; direct non-medical cost + indirect cost: $156), Jiangsu Province [35] (China, 2007–2008, direct economic cost: $1859.30) and Shanghai Province [36] (China, 1998, cost for acute care: $1209, cost for long-term care per year: $121). Compared to these estimates listed above, our study demonstrated a higher economic burden per case, the possible explanations are as follows: First, costs from our study were calculated from primary data sources, including medical records for laboratory-confirmed JE cases and face-to-face patient or guardian interview, which better ensured the accuracy of data

Summary

Introduction

Japanese encephalitis (JE), caused by Japanese encephalitis virus (JEV), is one of the most serious vector-borne viral encephalitis infections in Southeast Asia, the Western Pacific Region, and Northern Australia [1,2]. Symptomatic Japanese encephalitis is rare, and only approximately 1 in 250 infections results in severe clinical symptoms, the case fatality rate can be as high as 30% [2]. Permanent neurological or psychiatric sequelae can occur in 30%–50% of survivors, resulting in heavy health, social and economic burdens [2]. Japanese encephalitis (JE) is a mosquito-borne disease and associated with high mortality and disability rate among symptomatic cases. In the absence of local data, this study estimated the economic burden and the disability-adjusted life years (DALYs) due to JE in Zhejiang Province, China during 2013–2018, to increase disease awareness and provide evidence for effective health policy.

Objectives

Methods

Discussion

Conclusion