ARTICLE / ARTÍCULO 151 SALUD COLECTIVA, Buenos Aires, 8(2):151-162, May - August, 2012 Dengue in Argentina: an economic analysis of the impact of the 2009 epidemic Dengue en la Argentina: un análisis económico del impacto de la epidemia de 2009 Tarragona, Sonia1; Monteverde, Malena2; Marchioni, Silvia3; Caporale, Joaquín4; Pereiro, Ana Cristina5; Palacios, Julio Maximiliano6 1Bachelor’s Degree in ABSTRACT The present study estimates the economic burden associated with the cases Economics. Master’s Degree in Municipal and Provincial of dengue recorded during the 2009 Argentine epidemic. Among the costs considered Public Finance. Director of are the medical costs necessary for the treatment of those affected and the opportunity Fundación Mundo Sano, Argentina. costs for those who stopped working or studying because of the disease. In order to [email protected] assess the costs of the disease, at the end of 2009 an ad-hoc survey was carried out in 2Bachelor’s Degree in 201 households where people that had contracted dengue during the 2009 epidemic Economics. PhD in Economics. Researcher at the Centro de lived. The results allow us to estimate between 26 to 40 million Argentine pesos (6 to Investigaciones y Estudios 9 million US dollars) as the total cost of the recorded cases. The regions in the north sobre Cultura y Sociedad (CIECS), Consejo Nacional of Argentina bore the highest economic burden of the disease (more than 90% of the de Investigaciones Científi cas total burden). For all regions, the social cost of one dengue case accounts for more than y Técnicas (CONICET) and Universidad Nacional de 40% of the average monthly net individual income. Córdoba (UNC), Argentina. [email protected] KEY WORDS Dengue; Cost of Illness; Argentina. 3Bachelor’s Degree in Economics. Consultant at RESUMEN El presente estudio estima la carga económica de los casos notifi cados Fundación Mundo Sano, Argentina. de dengue durante la epidemia argentina de 2009. Entre los costos considerados, se [email protected] encuentran los costos médicos para el tratamiento de las personas afectadas y los costos 4Bachelor’s Degree in de oportunidad de aquellas personas que dejaron de trabajar o estudiar a causa de la Economics. Researcher at the Instituto de Efectividad Clínica enfermedad. Para la determinación de los costos, a fi nes de 2009 se llevó a cabo una y Sanitaria (IECS), Argentina. encuesta ad hoc a 201 hogares en los que habitaban personas que habían padecido la [email protected] enfermedad durante la epidemia. Los resultados obtenidos permiten estimar entre los 26 5Physician. Expert in Pediatrics. y los 40 millones de pesos (entre 6 y 9 millones de dólares) el costo total de los casos Expert in Public Health. Head of medical area at Fundación notifi cados. Las regiones del norte argentino son las que habrían soportado la mayor Mundo Sano, Argentina. carga económica (más del 90% de la carga total). Para todas las regiones, el costo social [email protected] de un caso de dengue representaría más del 40% de la remuneración neta mensual 6Physician. Researcher at promedio de los individuos. Instituto de Investigaciones de Enfermedades Tropicales (IIET), PALABRAS CLAVES Dengue; Costo de Enfermedad; Argentina. Argentina. Universidad Nacional de Lanús | Salud Colectiva | English Edition ISSN 2250-5334 | E-ISSN 1851-8265| ISSN-L 1669-2381 152 TARRAGONA S, MONTEVERDE M, MARCHIONI S, CAPORALE J, PEREIRO AC, PALACIOS JM INTRODUCTION the outbreak of the epidemic (as well as those implemented during or before it) are not included. The losses that the epidemic could have caused to In recent decades, the incidence of dengue specific economic activities (such as tourism) or to has increased dramatically around the world, and the aggregate economic growth of the region or it is estimated that 2.5 billion people (approxi- country affected – which could both be topics of mately two-fifths of the world population) are at further research – are also not included. risk. The Pan American Health Organization es- timates that each year 50 million dengue-related infections are reported worldwide (1). MATERIALS This disease is endemic in more than 100 countries in Africa, the Americas, Southeast Asia Quantities and the Western Pacific. At present, there is not SALUD COLECTIVA, Buenos Aires, 8(2):151-162, May - August, 2012 only a rise in the number of cases, but explosive The cost estimate was carried out taking into outbreaks are also becoming more frequent (2). The account the information regarding “quantities” most affected countries in the region are: Brazil, Ec- of goods and services consumed. This infor- uador, Colombia, Paraguay and Venezuela (3). mation was taken from an ad hoc survey carried The outbreak that Argentina faced in 2009 out during October and November of 2009 in was considered the worst dengue epidemic in the the affected zones. This survey allowed for the history of the country, due to both the number of detection of the average duration of the disease people affected and the geographic distribution (differentiating between outpatient and inpatient of the indigenous cases that exceeded the tradi- cases), the frequencies of use of medical goods tional endemic channels. According to official and services, and the frequencies related to op- figures, more than 27,000 cases were recorded, portunity costs (school days and workdays lost) and the most affected provinces were Chaco (42% for a sample of the dengue cases that took place of cases), Catamarca (33%), Salta (11%), Jujuy during the first half of 2009. The target population (5%), Santa Fe (4%), and Tucumán (2%), although of this analysis was made up of those affected there were also indigenous cases recorded in Mis- by the disease during the epidemic of 2009 in iones, Entre Ríos, and the city of Buenos Aires. Argentina. However, given the difficulties of car- The northern provinces of Argentina were at the rying out a survey covering the whole country and highest risk: the provinces of Chaco, Catamarca, the absence of a register of cases, the selection of and Salta alone accounted for almost 86% of the the sample was based on the population of one indigenous cases of dengue recorded during the endemic region of Argentina, critical in terms of first half of 2009 (4). the presence of dengue cases during the epidemic, The aim of this study is to estimate the ag- and where a thorough register including records gregate economic burden associated with the of the domiciles of the affected people which al- cases of dengue that occurred during the Ar- lowed subsequent contact was also kept. In light of gentine epidemic throughout the first half of the these considerations, the city selected was Orán, year 2009. In this estimate, the cost of the medical in the province of Salta, one of the cities with the services needed for the treatment of those affected highest number of cases in the province and one by the disease, as well as the opportunity cost for of the most affected in the country, and which has those individuals that discontinued their regular a distribution by age groups similar to the age dis- activities (like working or attending school) as a tribution of the country as a whole. The sample result of the disease are included. For the cost es- was composed of all the notified cases of dengue timate, a social perspective was adopted, in terms that were registered in the city of Orán during the of the costs to society as a whole, with no dis- epidemic. It is worth mentioning that this city had tinction between the different actors responsible precise information about the place of residence for those costs (patients, the State, families, etc.). of all the notified cases (which was not true for Cost estimates of the measures taken to all cases throughout the country). Two hundred prevent new cases that were implemented after and one cases of dengue were officially notified Universidad Nacional de Lanús | Salud Colectiva | English Edition ISSN 2250-5334 | E-ISSN 1851-8265| ISSN-L 1669-2381 DENGUE IN ARGENTINA: AN ECONOMIC ANALYSIS OF THE IMPACT OF THE 2009 EPIDEMIC 153 SALUD COLECTIVA, Buenos Aires, 8(2):151-162, May - August, 2012 in the city of Orán during the period of analysis. well as valuations in the public bid prices, av- The people affected were visited, and information erage unit prices were used in this study. was gathered by means of a structured question- For laboratory practices, the researchers took naire. To determine the proportions and quantities into consideration the prices that the subsystem of the services and inputs used, it is assumed that of Social Security uses, based on the information in all cases treated by public health care providers of the Unified Biochemical Confederation of the the clinical protocols recommended by the na- Argentine Republic [Confederación Unificada tional health authority were closely followed. This Bioquímica de la República Argentina] as well as allows for the assumption that there would not be information provided by private laboratories. significant variations regarding the health care pro- The medical consultations and hospitaliza- vided in other areas of the country. tions were valued according to the prices pro- vided by different health centers that belong to the private sub-sector of the provinces of Chaco, Prices Salta and Buenos Aires. In the case of hospitaliza- tions, prices from different catalogs used by the With the aim of minimizing the problems of provincial institutions of health insurance were valuation associated with the existence of sub- also taken into account. sidies, the prices of medical goods and services For the assignation of a value to the loss of (drugs, laboratory procedures, medical fees, and school days, the methodology of similar studies is hospitalization) of the private market were used followed, and it is considered that the economic whenever possible.