Background
Methods
Data
Conceptual framework
Antibiotics | Dose | Children | Adults (=>15 years) | Pregnant women | ||
---|---|---|---|---|---|---|
Under 1 year | 1–4 years | 5–14 years | ||||
Erythromycin 250 mg | 30 mg/kg divided 4 times per day for 3 days | 1/4 tablet 4 times/day 3 days | 1/2 tablet 4 times/day 3 days | 1 tablet 4 times/day 3 days | 2 tablets 4 times/day 3 days | 2 tablets 4 times/day 3 days |
Doxycline | 300 mg Single dose | 3 tablets | ||||
Ringer Lactate solution (IV) in litres | 1 litre per day for 3 days | 1 litre per day for 3 days | 1 litre per day for 3 days | 1 litre per day for 3 days | 1 litre per day for 3 days | 1 litre per day for 3 days |
Cost Estimation
Direct cost
Cost of medicines
"Hotel" cost of component of health centre consultations and hospitalizations
Cost of cholera diagnosis
Costs borne by households
Indirect cost
Cost of premature cholera-related mortality
Cost of productive time lost due to severe cholera
Cost of productive time lost due to mild/moderate cholera
Cost of productive time lost by care-givers accompanying patients for treatment
Results
Total costs
Scenario 1: At maximum life expectancy of 73 years
|
Scenario 2: At average life expectancy of 53 years
|
Scenario 3: At minimum life expectancy of 40 years
| ||||
---|---|---|---|---|---|---|
Summary of direct costs of cholera
|
US$
| % of grand TC |
US$
| % of grand TC |
US$
| % of grand TC |
(A). Direct costs
| ||||||
(1) Annual cost of medicines used in treating children and adults suffering mild/moderate cholera state at health centre | 185,334 | 0.29 | 185,334 | 0.35 | 185,334 | 0.48 |
(2) Annual cost of medicines used in treating children and adults suffering severe cholera state at hospitals | 71,561 | 0.11 | 71,561 | 0.13 | 71,561 | 0.18 |
(3) "Hotel" cost component of mild/moderate cholera cases consultations at health centres | 2,740,314 | 4.27 | 2,740,314 | 5.15 | 2,740,314 | 7.03 |
(4) "Hotel" cost component of severe cholera cases hospitalization | 651,741 | 1.02 | 651,741 | 1.22 | 651,741 | 1.67 |
(5) Cost cholera-related tests all cholera cases | 1,615,047 | 2.52 | 1,615,047 | 3.03 | 1,615,047 | 4.15 |
(6) Health care cost borne by households | 273,201 | 0.43 | 273,201 | 0.51 | 273,201 | 0.70 |
Total Direct Costs
|
5,537,198
|
8.62
|
5,537,198
|
10.40
|
5,537,198
|
14.21
|
(B) Indirect costs
| ||||||
(7) Cost of disablement among severe cases | 63,879 | 0.10 | 63,879 | 0.12 | 63,879 | 0.16 |
(8) Cost of disablement among mild/moderate cases | 531,242 | 0.83 | 531,242 | 1.00 | 531,242 | 1.36 |
(9) Cost of premature deaths | 56,691,858 | 88.29 | 45,723,836 | 85.88 | 31,441,728 | 80.71 |
(10) Productivity loss for care-givers | 1,384,702 | 2.16 | 1,384,702 | 2.60 | 1,384,702 | 3.55 |
Total Indirect Costs
|
58,671,681
|
91.38
|
47,703,659
|
89.60
|
33,421,551
|
85.79
|
Grand total cost
|
64,208,880
|
100
|
53,240,859
|
100
|
38,958,750
|
100
|
Scenario 1: At maximum life expectancy of 73 years
|
Scenario 2: At average life expectancy of 53 years
|
Scenario 3: At minimum life expectancy of 40 years
| ||||
---|---|---|---|---|---|---|
Summary of direct costs of cholera
|
US$
| % of grand TC |
US$
| % of grand TC |
US$
| % of grand TC |
(A). Direct costs
| ||||||
(1) Annual cost of medicines used in treating children and adults suffering mild/moderate cholera state at health centre | 277,058 | 0.18 | 277,058 | 0.22 | 277,058 | 0.30 |
(2) Annual cost of medicines used in treating children and adults suffering severe cholera state at hospitals | 107,950 | 0.07 | 107,950 | 0.08 | 107,950 | 0.12 |
(3) "Hotel" cost component of mild/moderate cholera cases consultations at health centres | 4,096,527 | 2.63 | 4,096,527 | 3.20 | 4,096,527 | 4.46 |
(4) "Hotel" cost component of severe cholera cases hospitalization | 1,062,965 | 0.68 | 1,062,965 | 0.83 | 1,062,965 | 1.16 |
(5) Cost cholera-related tests all cholera cases | 2,580,675 | 1.65 | 2,580,675 | 2.01 | 2,580,675 | 2.81 |
(6) Health care cost borne by households | 434,551 | 0.28 | 434,551 | 0.34 | 434,551 | 0.47 |
Total Direct Costs
|
8,559,726
|
5.49
|
8,559,726
|
6.68
|
8,559,726
|
9.32
|
(B) Indirect costs
| ||||||
(7) Cost of disablement among severe cases | 111,551 | 0.07 | 111,551 | 0.09 | 111,551 | 0.12 |
(8) Cost of disablement among mild/moderate cases | 919,340 | 0.59 | 919,340 | 0.72 | 919,340 | 1.00 |
(9) Cost of premature deaths | 143,984,575 | 92.30 | 116,128,266 | 90.63 | 79,854,920 | 86.93 |
(10) Productivity loss for care-givers | 2,418,069 | 1.55 | 2,418,069 | 1.89 | 2,418,069 | 2.63 |
Total Indirect Costs
|
147,433,535
|
94.51
|
119,577,226
|
93.32
|
83,303,880
|
90.68
|
Grand total cost
|
155,993,261
|
100
|
128,136,952
|
100
|
91,863,606
|
100
|
Summary of direct costs of cholera
|
Scenario 1: At maximum life expectancy of 73 years
|
Scenario 2: At average life expectancy of 53 years
|
Scenario 3: At minimum life expectancy of 40 years
| |||
---|---|---|---|---|---|---|
US$
| % of grand TC |
US$
| % of grand TC |
US$
| % of grand TC | |
(A). Direct costs
| ||||||
(1) Annual cost of medicines used in treating children and adults suffering mild/moderate cholera state at health centre | 140,729 | 0.19 | 140,729 | 0.23 | 140,729 | 0.32 |
(2) Annual cost of medicines used in treating children and adults suffering severe cholera state at hospitals | 54,508 | 0.07 | 54,508 | 0.09 | 54,508 | 0.13 |
(3) "Hotel" cost component of mild/moderate cholera cases consultations at health centres | 2,080,794 | 2.84 | 2,080,794 | 3.47 | 2,080,794 | 4.80 |
(4) "Hotel" cost component of severe cholera cases hospitalization | 510,332 | 0.70 | 510,332 | 0.85 | 510,332 | 1.18 |
(5) Cost cholera-related tests all cholera cases | 1,722,805 | 2.35 | 1,722,805 | 2.88 | 1,722,805 | 3.98 |
(6) Health care cost borne by households | 271,798 | 0.37 | 271,798 | 0.45 | 271,798 | 0.63 |
Total Direct Costs
|
4,780,966
|
6.58
|
4,780,966
|
7.98
|
4,780,966
|
11.04
|
(B) Indirect costs
| ||||||
(7) Cost of disablement among severe cases | 64,184 | 0.27 | 64,184 | 0.11 | 64,184 | 0.15 |
(8) Cost of disablement among mild/moderate cases | 532,118 | 2.27 | 532,118 | 0.89 | 532,118 | 1.23 |
(9) Cost of premature deaths | 65,892,630 | 89.90 | 53,144,560 | 88.70 | 36,544,544 | 84.37 |
(10) Productivity loss for care-givers | 1,391,308 | 1.03 | 1,391,308 | 2.32 | 1,391,308 | 3.21 |
Total Indirect Costs
|
67,880,240
|
93.42
|
55,132,170
|
92.02
|
38,532,154
|
88.96
|
Grand total cost
|
72,661,207
|
100
|
59,913,137
|
100
|
43,313,121
|
100
|
Average costs
Scenario 1: Maximum life expectancy of 73 years | Scenario 2: Average life expectancy of 53 years | Scenario 3: Minimum life expectancy of 40 years | |
---|---|---|---|
Types of costs per person
|
Cost per case (US$)
|
Cost per case (US$)
|
Cost per case (US$)
|
(1) Cost of medicines per mild/moderate cholera case | 1.6 | 1.6 | 1.6 |
(2) Cost of medicines per severe cholera case | 7.0 | 7.0 | 7.0 |
(3) Cost of health centre consultation per mild/moderate cholera case | 24.4 | 24.4 | 24.4 |
(4) Cost per hospital admission of per severe cholera case | 63.6 | 63.6 | 63.6 |
(5) Cost per cholera test | 12.9 | 12.9 | 12.9 |
(6). Health care cost borne by cholera patient
| 2.2 | 2.2 | 2.2 |
(7). Cost of productive time lost per severe cholera case | 6.2 | 6.2 | 6.2 |
(8). Cost of productive time lost per mild/moderate cholera case | 4.7 | 4.7 | 4.7 |
(9). Cost of productive time lost per premature death | 25422.4 | 20504.0 | 14099.4 |
(10). Cost of productive time lost in travel per care giver | 11.1 | 11.1 | 11.1 |
Scenario 1: Maximum life expectancy of 73 years | Scenario 2: Average life expectancy of 53 years | Scenario 3: Minimum life expectancy of 40 years | |
---|---|---|---|
Types of costs per person
|
Cost per case (US$)
|
Cost per case (US$)
|
Cost per case (US$)
|
(1) Cost of medicines per mild/moderate cholera case | 1.5 | 1.5 | 1.5 |
(2) Cost of medicines per severe cholera case | 6.5 | 6.5 | 6.5 |
(3) Cost of health centre consultation per mild/moderate cholera case | 22.6 | 22.6 | 22.6 |
(4) Cost of hospital admission per severe cholera case | 63.7 | 63.7 | 63.7 |
(5) Cost per cholera test | 12.7 | 12.7 | 12.7 |
(6). Health care cost borne by cholera patient
| 2.1 | 2.1 | 2.1 |
(7). Cost of productive time lost per severe cholera case | 6.7 | 6.7 | 6.7 |
(8). Cost of productive time lost per mild/moderate cholera case | 5.1 | 5.1 | 5.1 |
(9). Cost of productive time lost per premature death | 27264.6 | 21989.8 | 15121.2 |
(10). Cost of productive time lost in travel per care giver | 11.9 | 11.9 | 11.9 |
Scenario 1: Maximum life expectancy of 73 years | Scenario 2: Average life expectancy of 53 years | Scenario 3: Minimum life expectancy of 40 years | |
---|---|---|---|
Types of costs per person
|
Cost per case (US$)
|
Cost per case (US$)
|
Cost per case (US$)
|
(1) Cost of medicines per mild/moderate cholera case | 1.4 | 1.4 | 1.4 |
(2) Cost of medicines per severe cholera case | 6.0 | 6.0 | 6.0 |
(3) Cost of health centre consultation per mild/moderate cholera case | 20.9 | 20.9 | 20.9 |
(4) Cost of hospital admission per severe cholera case | 56.2 | 56.2 | 56.2 |
(5) Cost per cholera test | 15.5 | 15.5 | 15.5 |
(6). Health care cost borne by cholera patient | 2.5 | 2.5 | 2.5 |
(7). Cost of productive time lost per severe cholera case | 7.1 | 7.1 | 7.1 |
(8). Cost of productive time lost per mild/moderate cholera case | 5.4 | 5.4 | 5.4 |
(9). Cost of productive time lost per premature death | 28811.8 | 23237.7 | 15979.2 |
(10). Cost of productive time lost in travel per care giver | 12.6 | 12.6 | 12.6 |
Scenario 1: Maximum life expectancy of 73 years | Scenario 2: Average life expectancy of 53 years | Scenario 3: Minimum life expectancy of 40 years | |
---|---|---|---|
Types of costs per person
|
Average cost per person with cholera US$)
|
Average cost per person with cholera (US$)
|
Average cost per person with cholera (US$)
|
(1) Cost of medicines | 2.1 | 2.1 | 2.1 |
(2) Cost of consultation/hospitalization | 27.1 | 27.1 | 27.1 |
(3) Cost of cholera test | 12.9 | 12.9 | 12.9 |
(4). Health care cost borne by cholera patient | 2.2 | 2.2 | 2.2 |
(5). Cost of productive time lost | 15.8 | 15.8 | 15.8 |
(6). Cost of productive time lost due to premature death | 453.5 | 365.7 | 251.5 |
(7). Total cost per person with cholera | 513.6 | 425.9 | 311.6 |
Scenario 1: Maximum life expectancy of 73 years | Scenario 2: Average life expectancy of 53 years | Scenario 3: Minimum life expectancy of 40 years | |
---|---|---|---|
Types of costs per person
|
Average cost per person with cholera US$)
|
Average cost per person with cholera (US$)
|
Average cost per person with cholera (US$)
|
(1) Cost of medicines | 1.9 | 1.9 | 1.9 |
(2) Cost of consultation | 25.3 | 25.3 | 25.3 |
(3) Cost of cholera test | 12.7 | 12.7 | 12.7 |
(4). Health care cost borne by cholera patient | 2.1 | 2.1 | 2.1 |
(5). Cost of productive time lost | 16.9 | 16.9 | 16.9 |
(6). Cost of productive time lost due to premature death | 707.3 | 570.5 | 392.3 |
(7). Total cost per person with cholera | 766.3 | 629.5 | 451.3 |
Scenario 1: Maximum life expectancy of 73 years | Scenario 2: Average life expectancy of 53 years | Scenario 3: Minimum life expectancy of 40 years | |
---|---|---|---|
Types of costs per person
|
Average cost per person with cholera US$)
|
Average cost per person with cholera (US$)
|
Average cost per person with cholera (US$)
|
(1) Cost of medicines | 1.8 | 1.8 | 1.8 |
(2) Cost of consultation | 23.4 | 23.4 | 23.4 |
(3) Cost of cholera test | 15.5 | 15.5 | 15.5 |
(4). Health care cost borne by cholera patient | 2.5 | 2.5 | 2.5 |
(5). Cost of productive time lost | 23.7 | 23.7 | 23.7 |
(6). Cost of productive time lost due to premature death | 594.5 | 479.5 | 329.7 |
(7). Total cost per person with cholera | 655.6 | 540.6 | 390.8 |
Discussion
Key findings
Limitations of the study
a) Use of the standard treatment guidelines
b) Assumption that those who suffer cholera mortality would have future earning
c) Assumption that all cholera cases receive a diagnostic test
d) Omission of intangible costs
e) Use of per capita GNI to value-productive time lost
f) Omission of economic effects of cholera outbreaks on tourism and commodity export
Conclusion
-
national-level economic burden of cholera, broken down by different productive and social sectors and occupations of patients and relatives; and
-
national-level costs, effectiveness and monetary benefits of alternative ways of scaling up population coverage of appropriate potable water and clean sanitation facilities in rural, peri-urban and urban areas.