Economic and Health Burden of Rotavirus Gastroenteritis in Latin America

Objective. To estimate the health and economic burden of rotavirus gastroenteritis in hospital and outpatient settings in eight Latin American and Caribbean countries (Argentina, Brazil, Chile, Dominican Republic, Honduras, Mexico, Panama, and Venezuela). Methods. An economic model was constructed using epidemiological data from published articles, national health administration studies, and country-specific cost estimates. For each of the eight countries, the model estimated the rotavirus outcomes for the 2003 birth cohort during the first five years of life. The main outcome measures included health care costs, transportation costs, lost wages, and disease burden expressed in disability-adjusted life years. Estimates were expressed in 2003 US dollars. All future costs and disability-adjusted life year estimates were discounted at a rate of 3%. Sensitivity analyses evaluated the impact of specific variables on the medical cost of treating rotavirus. Results. For every 1 000 children born during 2003 in the eight Latin American and Caribbean countries studied here, we estimated that rotavirus gastroenteritis would result in an average of 246 outpatient visits, 24 hospitalizations, 0.6 deaths, and US$ 7 971 in direct medical costs during their first five years of life. The incidence of rotavirus-associated outpatient visits and the cost of outpatient visits were predicted to have the largest impact on the total medical cost per child. Conclusions. Rotavirus gastroenteritis is likely to result in substantial disease and economic burden to health systems in Latin American and Caribbean countries, and the foreseeable burden should be an important consideration in evaluating the cost-effectiveness of vaccination. Rheingans RD, Constenla D, Antil L, Innis BL and Breuer T (2007) "Economic and Health Burden of Rotavirus Gastroenteritis in Latin America" J Pan Am Health Org 21(4) pp. 192-204 Version of Record Available From www.scielosp.org Rotavirus is the most important viral cause of acute gastroenteritis in children under 5 years of age, causing severe dehydrating diarrhea and vomiting in infants and young children worldwide. In Latin America, it is estimated that rotavirus gastroenteritis is associated with more than 15 000 deaths in under children under 5 years of age (1). In addition, several studies have documented that rotavirus gastroenteritis is a common cause of hospitalization in children of this age group (1–7). A recent review of 28 studies of children hospitalized with severe diarrhea in Latin America found that 31% to 38% of those hospitalizations were attributed to rotavirus gastroenteritis (8). Although the main impact of rotavirus gastroenteritis is the morbidity and mortality it causes in children, information on the economic burden of disease can aid decisionmakers in choosing interventions to improve health. With the development of rotavirus vaccines, information on the economic burden of rotavirus and the potential costs averted by vaccination can provide decisionmakers with an estimate of the net impact of vaccination on financial resources, either in the health sector or for society as a whole. Few studies have evaluated the economic burden imposed by rotavirus gastroenteritis in Latin America. Among publications retrieved by a MEDLINE search of health economic studies of rotavirus or gastroenteritis from 1995 to 2005, only one study was undertaken in Latin America (6). According to this study, the Peruvian Ministry of Health was estimated to spend over US$ 2.6 million annually to treat young children with rotavirus gastroenteritis (6). The purpose of this study was to estimate the impact of rotavirus gastroenteritis in children on the cost of direct medical treatment to the health care system in eight Latin American and Caribbean countries: Argentina, Brazil, Chile, the Dominican Republic, Honduras, Mexico, Panama, and Venezuela. In addition to health care costs, nonmedical direct (e.g., transportation) and indirect costs (e.g., productivity losses) were also considered. The results should provide insight into the reductions that could be achieved in the disease and economic burden by preventing rotavirus infection.