Indirect costs associated with deaths of children aged 0-14 years from measles in a weak health system and conflict and fragile zone: the case of Somalia.

Omar B Da'Ar

doi:10.1017/s0950268819001420

Abstract

This study recognises periodic outbreaks of measles continue to affect conflict and fragile zones in the least developed countries. This study set out to provide evidence for the indirect costs or economic loss associated with measles-related deaths among children aged 0-14 years in Somalia. Using epidemiologic and economic data, the indirect cost was calculated based on the framework of the World Health Organisation guide of identifying the economic consequences of disease and injury. The baseline indirect cost was computed as the product of discounted future productive years of life lost (PYLL), non-health gross domestic product per capita (NHGDPPC) and the estimated total measles deaths (ETMD). The model was adjusted for conflict and fragility conditions and further extension considered a finite and stable upper limit growth of the instability-adjusted NHGDPPC. To discount future costs, a rate of 3% was applied. Using a ±20% variability assumption of the epidemiologic and economic factor inputs, a sensitivity analysis was conducted to account for uncertainty. In 2015 values, the ETMD of 3723 measles deaths of children aged 0-14 years could decrease non-health GDP of the country by $23.46 million, a potential loss of $6303 per death over the discounted PYLL. The loss would increase by 5.3% when adjusted for conflict and fragility conditions. Assuming growth, the future adjusted loss is expected to be $35.91 million in 2015 values. Girl-child deaths accounted for 51.2% of the burden. Results are robust to the variations in the model inputs, although sensitivity analyses suggest the proportion of total measles deaths and the discount rate accounted for greater uncertainty of the loss than do the proportion of growth and instability assumption. Conflict and fragility accounted for the least uncertainty, perhaps confirming their relative perpetuity in Somalia. Results show significant indirect cost related to measles deaths of children, exacerbated by conflict and fragility. This is an economic burden, but one which the health system, policy-makers, government and other stakeholders should be prepared to colossally discount by collectively taking measles surveillance and security measures now to reduce further deaths in the future.

Highlights

Global mortality attributed to measles has been on the decline in recent decades [1], significantly contributing to the overall decrease in childhood mortality [2]
The paper used a macroeconomic model of cost-of-illness (COI) within the framework of recommendations of reporting economic evaluations according to the World Health Organisation (WHO) guideline for identifying the economic consequences of disease and injury [16]
In 2015, the estimated total measles deaths (ETMD) of the population aged less than 65 years was 8617

Summary

Introduction

Global mortality attributed to measles has been on the decline in recent decades [1], significantly contributing to the overall decrease in childhood mortality [2]. Most countries achieved the 2010 global goal of reducing measles mortality by 90% and evidence of measurable progress by 2015 target [3] has recently generated optimism that global eradication is feasible by 2020. Accelerated measles control activities, financial and technical support by high-burden countries have made possible much of the recent progress. In spite of such progress and availability of vaccines, periodic outbreaks of measles continue to appear in many parts of the world including under-vaccinated populations [4] and developed countries [5, 6]. The short-term horizon of 2020 and re-emergence of measles even in traditionally low-burden countries appear to dampen the recent optimism about the disease eradication

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Discussion

Conclusion