Cost of Illness Due to Severe Enteric Fever in India

Abstract

Background: Lack of robust data on economic burden due to enteric fever in India has made decision making on typhoid vaccination a challenge. Surveillance for Enteric Fever network was established to address gaps in typhoid disease and economic burden.

Methods: Patients hospitalized with blood culture-confirmed enteric fever and nontraumatic ileal perforation were identified at 14 hospitals. These sites represent urban referral hospitals (tier 3) and smaller hospitals in urban slums, remote rural, and tribal settings (tier 2). Cost of illness and productivity loss data from onset to 28 days after discharge from hospital were collected using a structured questionnaire. The direct and indirect costs of an illness episode were analyzed by type of setting.

Results: In total, 274 patients from tier 2 surveillance, 891 patients from tier 3 surveillance, and 110 ileal perforation patients provided the cost of illness data. The mean direct cost of severe enteric fever was US$119.1 (95% confidence interval [CI], US$85.8-152.4) in tier 2 and US$405.7 (95% CI, 366.9-444.4) in tier 3; 16.9% of patients in tier 3 experienced catastrophic expenditure.

Conclusions: The cost of treating enteric fever is considerable and likely to increase with emerging antimicrobial resistance. Equitable preventive strategies are urgently needed.

Keywords: India; cost of illness; economic burden; enteric fever; health expenditure; ileal perforation; out of pocket expenditure; typhoid.

Figure 1.

Source of financing for severe enteric fever. Tier 2; surveillance in smaller hospitals in 5 rural sites and 1 urban site; tier 3, surveillance in 8 key tertiary care hospitals. *Four patients in tier 3 did not report their source of finance. †A person is said to be under distress financing when they spend by borrowing or selling of assets.

Figure 2.

Percentage of households spending above the cutoff on health care due to enteric fever. Distribution of direct medical expenses for enteric fever as a proportion of capacity to pay.. Catastrophic health expenditure was not computed for 1 subject with no expenses.