Abstract
Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian reservations in Arizona. RMSF causes an acute febrile illness that, if untreated, can cause severe illness, permanent sequelae requiring lifelong medical support, and death. We describe costs associated with medical care, loss of productivity, and death among cases of RMSF on two American Indian reservations (estimated population 20,000) between 2002 and 2011. Acute medical costs totaled more than $1.3 million. This study further estimated $181,100 in acute productivity lost due to illness, and $11.6 million in lifetime productivity lost from premature death. Aggregate costs of RMSF cases in Arizona 2002–2011 amounted to $13.2 million. We believe this to be a significant underestimate of the cost of the epidemic, but it underlines the severity of the disease and need for a more comprehensive study.
Highlights
We describe costs associated with medical care, loss of productivity, and death among cases of Rocky Mountain spotted fever (RMSF) on two American Indian reservations between 2002 and 2011
Rocky Mountain spotted fever (RMSF) is a tick-borne rickettsial disease caused by the bacterium Rickettsia rickettsii
RMSF has been endemic in parts of the United States for well over a century, but emerged on tribal lands of Arizona in 2003.1 From 2000 to 2007, it was demonstrated that American Indians were experiencing a disproportionate burden of disease compared with other race groups.[2]
Summary
The number of days of productivity lost due to RMSF was calculated by combining the number of days spent at each health-care visit (this would include 1 day for outpatient or ER visits and any inpatient days) plus 4 days for recovery regardless of disease severity. Age and gender-specific daily production values from Grosse and others,[9] which were adjusted for inflation and local annual income, were applied to the number of productivity days lost. To calculate potential earnings lost from a premature death due to disease, we used the age- and gender-specific lifetime productivity estimates from Grosse and others, and adjusted them based on local annual income, as was done for acute productivity lost.[9] Using the age at death for each of the fatal cases, we applied the population-adjusted age and gender-specific lifetime production lost at a 3% discount rate. Acute medical costs based on IHS all-inclusive reimbursement rates from Medicaid
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