Key Concept

Key Evidence: In a standardized survey of the costs of dengue illness in three highly endemic countries, the economic burden of dengue was greatest on Vietnamese and Colombian low-income families, whose total costs, including lost wages, outpatient and inpatient cases combined, average 36-45% of their monthly household income. In Thailand, although significant, the economic burden was 17% less than the other countries, due to Thailand's universal health insurance system.

Lee JS, Mogasale, V, Lim JK et al 2017. A multi-country study of the economic burden of dengue fever: Vietnam, Thailand, and Colombia. PLoS NTD. 11(10).
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Key Evidence: A study in Bangladesh found that families are heavily borrowing or losing assets to be able to bear the cost of pneumonia in their children <5 years of age.

Alamgir, N.I., Naheed, A., and Luby, S.P 2010. Coping strategies for financial burdens in families with childhood pneumonia in Bangladesh. BMC Public Health. 10(622).
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Key Evidence: Three studies in Bangladesh and India found that the direct medical costs for children hospitalized with pneumonia were 27% to 116% of the average monthly income of households. And, while these costs represent a major portion of a family’s monthly income, they don’t include non-medical costs, such as transport and food costs, nor the lost wages of family members who miss work to care for the child.

Zhang S, Sammon PM, King I, et al. 2016. Cost of management of severe pneumonia in young children: systematic analysis. Journal of Global Health. 6(1).
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Key Evidence: During a meningococcal meningitis epidemic in Burkina Faso, households spent, on average, US$90 for treatment and other direct costs for family members with the disease. These costs, the equivalent of one third of the country's annual GDP per capita, were in addition to the loss of income and assets from family members caring for patients.

Colombini A, Badolo O, Gessner BD et al. 2011. Costs and impact of meningitis epidemics for the public health system of Burkina Faso. Vaccine. 29(33).
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Key Evidence: Costs for treatment for rotavirus at a large urban hospital in Malaysia led one third of families to experience catastrophic health expenditures (CHC). When direct and indirect costs of treating rotavirus were considered, almost 9 in 10 families spent more than 10% of their monthly household income on treating rotavirus. In addition, 6% of families were pushed into poverty after paying for treatment.

Loganathan, T., Lee, W.S., Lee, K.F., et al 2015. Household Catastrophic Healthcare Expenditure and Impoverishment Due to Rotavirus Gastroenteritis Requiring Hospitalization in Malaysia. PLOS One. 10(5).
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Key Evidence: Children with rotavirus experience longer hospital stays than children with non-rotavirus diarrhea. In a study looking at the direct and indirect costs of treating rotavirus in Malaysia, rotavirus hospitalizations cost families 26% of their average total monthly household income, which was significantly higher than the cost for non-rotavirus diarrhea hospitalizations.

Chai, P.F., and Lee W. S. 2009. Out-of-pocket costs associated with rotavirus gastroenteritis requiring hospitalization in Malaysia. Vaccine. 27(5).
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Key Evidence: In a 2002 study from Cambodia, households with a dengue patient had to borrow money at high interest rates and lose productive assets (land) to repay debts linked to healthcare costs. Public healthcare cost significantly less than private healthcare but was either not present where people lived or did not have a good reputation.

Van Damme, W., Van Leemput, L., Por, I., et al 2004. Out-of-pocket health expenditure in poor households: evidence from Cambodia. Tropical Medicine and International Health. 9(2).
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Key Evidence: In 41 Gavi-eligible countries it is estimated that, in the absence of any measles vaccine use, approximately 18.9 million households would have Catastrophic Health Costs (CHC) attributable to measles. The number of CHC decreases to 3.4 million households in these countries if the current vaccine coverage forecasts is unchanged and decreases to 2.6 million cases if coverage was enhanced with Gavi support. Overall, optimizing vaccine coverage for measles can reduce by approximately 90% the incidence of CHC due to measles disease.

Riumallo-Herl, C., Chang, A.Y., Clark, S., et al. 2018. Poverty reduction and equity benefits of introducing or scaling up measles, rotavirus, and pneumococcal vaccines in low-income and middle-income countries: a modeling study. British Journal of Medicine Global Health. 3:e000612.
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