Abstract
There has been a shift in the global burden of disease from communicable non-communicable disease. Interestingly, global dengue cases have been increasing over the decades. Prognosis of dengue varied from asymptomatic to fatal cases with outbreaks often occurred. As a consequence, the economic burden due to dengue is a threat to endemic countries. We estimated the cost of dengue illness in Indonesia using mix approach of macro- and micro-costing. We gathered financial and utilization data of health facilities (hospitals and primary cares) and interviewed respondents’ cases for hospital, ambulatory and non-medical cares in Yogyakarta City. We analyzed the cost per patient and the portion of that paid by households and other paying mechanisms. To obtain the estimation of dengue cases and cost in Indonesia, part of our study produced consensus estimates using statistical and mathematical modeling. We summed the total cost of dengue illness and multiplied to our estimation of dengue cases to obtain the estimated national cost. Dengue cost per case for hospital, ambulatory and non-medical treatments were US$ 318.36 (95%UI 243.93-392.79), US$ 23.03 (95%UI 14.45-31.62) and US$ 7.53 (95%UI 2.37-12.68), respectively. There was a total of 7.535 million (95%UI 1.319-16.513 million) dengue cases in 2017 and our national estimate suggests that the economic cost of dengue in Indonesia was US$ 666.83 million (95%UI 531.57-802.08 million). To this figure, about 37%, 20%, 25% and 18% paid by the households, social contributors, Indonesian National Health Insurance Program (Jaminan Kesehatan Nasional/JKN) and other parties, respectively. In conclusion, the cost of dengue illness will be useful in Indonesia and in other countries. This economic analysis is informing out-of-pocket expenditures and direct and indirect costs within three different treatment settings. Hence
there are needs for refinement of dengue policy options to existing and promising interventions e.g. vaccine and Wolbachia technologies which are attributed to lowering economic burden.