The burden of dengue

THE loss of billions of pesos due to dengue could be halved by simply confirming an initial diagnosis.

It costs an estimated P1.1 billion to diagnose and treat unconfirmed cases of dengue, yet only half the amount, or P500 million, is spent in similar costs when the diagnosis is confirmed. according to “Burden of Disease and Economic Impact of Dengue,” a research paper by the National Institute of Health and the U.P. College of Public Health.

The economic costs of dengue in the Philippines is staggering. An estimated P367 billion is lost due to illness resulting from dengue, while 18,074 DALYs (disability adjusted life years lost) are lost every year.

DALY is the sum of Years of Life Lost due to premature mortality and Years lived with Disability due to dengue. It was developed by the World Bank as a “health indicator for priority setting”‘ according to the paper.

Dengue is expensive to diagnose because it entails a series of laboratory tests. The average cost of diagnosis per patient is P5,050. This costs more than the average therapeutic management for dengue, which costs about P4,387. If the estimated total of 112,708 suspected dengue cases in the Philippines were to undergo diagnostic confirmation, it would cost an additional P120.4 million.

Yet by confirming the diagnosis of patients, the additional P428.5 million spent to treat unconfirmed dengue cases would be saved, on top of a hefty P548.8 million savings in treatment.

Millions of pesos in savings would have a big impact on the National Dengue Prevention and Control Programme (NDPCP). Due to devolution, the NDCP’s national budget of $16 million was reduced tenfold to $1.6 million.

Under devolution, the responsibility for the prevention and control of dengue has been passed on to local government units. Yet many still persist in practicing wrong methods of dengue control.

In spite of the Department of Health’s efforts to increase public awareness concerning dengue, some LGU’s continue to undertake unnecessary fogging. Fogging is a high-profile action, a way for politicians to garner publicity and reassure their constituents that they are fighting dengue, according to Dr. Eric Tayag, director of the National Epidemiology Center. Yet fogging is only effective in areas hit by an epidemic, where there are large numbers of adult mosquitoes.

By demonstrating the burden of dengue, researchers hope to convince LGU’s to include dengue among priority public health problems that need to be addressed.

A reliable diagnostic test is needed in order to save costs and improve the surveillance of dengue. Eighty-one percent of dengue cases are not reported, according to the paper.

Dengue cases could be confirmed if LGU’s would implement a formal local dengue program, with its own staff, budget and organization.

Such programs would form part of an integrated health system, which is vital in responding to public health issues such as dengue. According to Dr. Jaime Montoya, head of the Philippine National Health Research System, “We cannot hope to immediately address urgent issues in a timely manner if there’s no integrated health system in place.”