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Am J Trop Med Hyg. 2019 Jun;100(6):1525-1533. doi: 10.4269/ajtmh.18-0780.

A Prospective Study on the Impact and Out-of-Pocket Costs of Dengue Illness in International Travelers.

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New York University College of Global Public Health, New York, New York.
New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.
Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden.
Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Sheba Medical Center, Institute of Tropical and Travel Medicine, Ramat-Gan, Israel.
Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
School of Public Health and Preventive Medicine, Monash University and Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, Australia.
Centre for Tropical Diseases, IRCCS Hospital Sacro Cuore-Don Calabria, Verona, Italy.
University of Basel, Basel, Switzerland.
Swiss Tropical and Public Health Institute, Basel, Switzerland.
Mount Auburn Hospital, Cambridge, and Harvard Medical School, Boston, Massachusetts.
Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Heidelberg Global Health Institute, University of Heidelberg, Heidelberg, Germany.


Although the costs of dengue illness to patients and households have been extensively studied in endemic populations, international travelers have not been the focus of costing studies. As globalization and human travel activities intensify, travelers are increasingly at risk for emerging and reemerging infectious diseases, such as dengue. This exploratory study aims to investigate the impact and out-of-pocket costs of dengue illness among travelers. We conducted a prospective study in adult travelers with laboratory-confirmed dengue and recruited patients at travel medicine clinics in eight different countries from December 2013 to December 2015. Using a structured questionnaire, we collected information on patients and their health-care utilization and out-of-pocket expenditures, as well as income and other financial losses they incurred because of dengue illness. A total of 90 patients participated in the study, most of whom traveled for tourism (74%) and visited countries in Asia (82%). Although 22% reported hospitalization and 32% receiving ambulatory care while traveling, these percentages were higher at 39% and 71%, respectively, after returning home. The out-of-pocket direct and indirect costs of dengue illness were US$421 (SD 744) and US$571 (SD 1,913) per episode, respectively, averaging to a total out-of-pocket cost of US$992 (SD 2,052) per episode. The study findings suggest that international travelers incur important direct and indirect costs because of dengue-related illness. This study is the first to date to investigate the impact and out-of-pocket costs of travel-related dengue illness from the patient's perspective and paves the way for future economic burden studies in this population.

[Available on 2020-06-01]

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