Calculation of the Average Cost per Case of Dengue Fever in Mexico Using a Micro-Costing Approach

Introduction: The increasing burden of dengue fever (DF) in the Americas, and the current epidemic in previously unaffected countries, generate major costs for national healthcare systems. There is a need to quantify the average cost per DF case. In Mexico, few data are available on costs, despite DF being endemic in some areas. Extrapolations from studies in other countries may prove unreliable and are complicated by the two main Mexican healthcare systems (the Secretariat of Health [SS] and the Mexican Social Security Institute [IMSS]). The present study aimed to generate specific average DF cost-per-case data for Mexico using a micro-costing approach. Methods: Expected medical costs associated with an ideal management protocol for DF (denoted ´ideal costs´) were compared with the medical costs of current treatment practice (denoted ´real costs´) in 2012. Real cost data were derived from chart review of DF cases and interviews with patients and key personnel from 64 selected hospitals and ambulatory care units in 16 states for IMSS and SS. In both institutions, ideal and real costs were estimated using the program, actions, activities, tasks, inputs (PAATI) approach, a micro-costing technique developed by us. Results: Clinical pathways were obtained for 1,168 patients following review of 1,293 charts. Ideal and real costs for SS patients were US$165.72 and US$32.60, respectively, in the outpatient setting, and US$587.77 and US$490.93, respectively, in the hospital setting. For IMSS patients, ideal and real costs were US$337.50 and US$92.03, respectively, in the outpatient setting, and US$2,042.54 and US$1,644.69 in the hospital setting. Conclusions: The markedly higher ideal versus real costs may indicate deficiencies in the actual care of patients with DF. It may be necessary to derive better estimates with micro-costing techniques and compare the ideal protocol with current practice when calculating these costs, as patients do not always receive optimal care. Author Summary: Dengue fever (DF) is caused by infection with the dengue virus, which is spread by the Aedes aegypti mosquito. Although the effects of DF are usually mild, in some cases serious illness and even death may result. The average costs per case when extrapolated to society may therefore be high, particularly given the large number of people infected during an endemic year. In Mexico, relatively little is known about the average cost per case (from either the healthcare system or the patient perspective). Such information is important to guide decisions about health policy, e.g. vaccination or public education. We aimed to quantify the average cost per case of DF using a micro-costing approach, both for DF treatment according to an ideal protocol for the management of the patient (´ideal costs´) and according to current treatment practice in the health services (´real costs´). Our results were largely consistent with findings from other international studies, but showed higher ideal costs compared with real costs. We think this may point to inadequate use of laboratory tests and treatments for patients with DF in Mexico. Our cost data will be used in a subsequent publication regarding the economic impact of DF in Mexico.