Caracterização dos custos diretos e indiretos de dengue em Mato Grosso do Sul

Abstract

Background: Records of Dengue epidemics in Brazil are frequent, the severity of the cases and the number of hospitalizations has increased, affecting the economy negatively. In the period 2016 and 2017, 68.9% and 43.4% of all registered cases in Latin America occurred in Brazil. Some studies have shown that public and private expenditures with hospitalizations can consume around 2.5% of the Domestic Product Gross of the municipality during an epidemic. Mato Grosso do Sul, has reported high incidence of the disease in recent years, however, there are no studies about the economic impact of dengue from a society perspective in this State. Objectives: To estimate the economic impact of dengue from a societal perspective, by analyzing the direct and indirect costs generated as a result of the disease; carry out a survey ofdirect and indirect medical costs, in the care of patients diagnosed with hospitalized dengue or accompanied outpatient in the public and private sector, stratifying costs by age group.Material and Methods: We carried out a prospective cohort, using the perspective of the society with a bottom-up approach during the non-epidemic period from March 2016 to December 2017 in Dourados city - MS. The sample was of non-probabilistic type and the place of triage of the patients occurred in 05 institutions: 03 hospitals, being 01 public, 01 first-aid center and 01 health primary care. During the cohort, socioeconomic and epidemiological information was collected, as well as direct medical and non-medical costs and indirect costs. Results: Based on the results, 02 articles were written: in the first, we analyzed the cases of hospitalized patients who used blood products. Of the 323 patients followed up, 52 were transfused, of which 52% were without WHO criteria recommendations (n = 27) and 271 were not transfused, of which 4.4% (n = 12) with transfusion criteria. The hospitalization costs were 41% higher in the transfused group without criteria than in those with criteria (median of US $ 674.3 vs US $ 478 p = 0.293). The multivariate analysis using time of hospital stay and costs as a dependent variable showed that receiving transfusion increased hospitalization time by 1.29 days (p = 0.0007; IRR = 1.29), and costs were 5.1 times higher than among those who were not transfused (IRR = 5.1, p <0.001, median US $ 504.4 vs US $ 170.7). The second article describes the direct and indirect costs of ambulatory and hospitalized cases stratified by age group and by health system (public or private). The costs of hospitalized and ambulatorycases corresponded to 84.3% and 29.7% of monthly family income, respectively. The average cost of ambulatory and hospitalized cases in the public sector was US $ 109 (DP 117) and US $ 322 (DP 361.4), respectively. In the public sector, costs were US $ 170.6 (SD 199.7) in ambulatory cases and U $$ 444 (DP422.1) in hospitalized patients, a statistically significant difference (p <0.05). The majority of cases occurred among adults (76%). Conclusion: Dengue causes a large loss in family income and not to use WHO recommendation for transfusion worsens this scenario. Our results could be contributed to cost-effectiveness studies as it provides valuable information to society and publics managers that will assist them in making decisions in the management of resources for the use of new technologies in the fight against dengue and his vector.