Direct Costs of Dengue Hospitalization in Brazil: Public and Private Health Care Systems and Use of WHO Guidelines

Background: Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. Methods and Results: To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). Conclusion: The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care. Author Summary: The costs of dengue outbreaks and hospitalizations have recently increased. Endemic in many tropical and subtropical parts of the world, dengue outbreaks occur each year and require appropriate economic studies to determine the potential financial and public health impacts of dengue management policies. Economic literature on this topic is rare, and results are conflicting, because inconsistent assumptions are used. Health economics research specific to dengue is critical for controlling and preventing this disease. In Brazil, health care is the federal government's responsibility and is provided by the private and public health care systems; however, during an outbreak, both systems become overcrowded. Municipal governments are responsible for administering health care, with technical and financial cooperation from the government and states. The data presented here reveal the direct hospitalization costs, the private and public health care systems' costs and the impact of using the WHO guidelines on both systems. Together, these data will aid health care workers, researchers and health policy makers in financing the prevention, control and treatment of dengue fever.