The economic burden of diarrheal disease in a tertiary level hospital, Gauteng, South Africa.

BACKGROUND Diarrheal disease remains one of the major causes of morbidity and mortality in young children in South Africa. Although a rotavirus vaccine will reduce rotavirus diarrheal morbidity and mortality, its introduction and sustainability will incur considerable costs. The aim of this study was to estimate the costs associated with diarrheal disease of all etiologies in children <5 years of age at Dr George Mukhari Hospital, a tertiary level hospital in Gauteng, South Africa. METHODS Cost data were obtained by a review of systematically selected records of patients admitted for diarrhea during 2004 and the prospective recording of the treatment of consecutive inpatients admitted for diarrhea from February through June 2005. Data on hospital stay, medications, nondrug orders, and diagnostic tests were abstracted using standardized recording forms. Costs were calculated using 2004 and 2005 prices. Carers were interviewed using a standard interview schedule to determine out-of-pocket expenses. Stool samples were tested for rotavirus by the Medical Research Council Diarrheal Pathogens Unit. RESULTS The review sample comprised 86 (20 rotavirus positive) patient records. The prospective sample comprised 77 inpatients (25 rotavirus positive). The mean duration (+/- standard deviation [SD]) of hospital stay was 4.6 +/- 3.4 days and 5.7 +/- 4.7 days for the review and prospective samples, respectively. The mean total inpatient cost (+/-SD) was R5963 +/- R4070 (review sample) and R7256 +/- R5599 (prospective sample; P > .05). Although mean total costs did not differ significantly between rotavirus-negative and -positive samples, mean facility and antibiotic costs were significantly higher for the rotavirus-negative sample (P < .05) in the prospective sample. Mean out-of-pocket expenses (+/-SD) were R100.00 +/- R112 for inpatients. CONCLUSION Although total inpatient costs did not differ significantly between the rotavirus-negative and -positive patients, costs for the rotavirus-negative patients tended to be higher. Although a rotavirus vaccine will reduce the burden of diarrheal disease, it is imperative that measures for reducing the incidence and severity of diarrheal disease due to other pathogens are strengthened.