Costs of illness due to typhoid fever in an Indian urban slum community: implications for vaccination policy
Bahl, R.; Sinha, A.; Poulos, C.; Whittington, D.; Sazawal, S.; Kumar, R.; Mahalanabis, D.; Acosta, C.J.; Clemens, J.D.; Bhan, M.K.
Journal of Health Population and Nutrition 22(3): 304-310
2004
ISSN/ISBN: 1606-0997 PMID: 15609783 Document Number: 238415
A one-year prospective surveillance (November 1995-October 1996) was conducted in an urban slum community in Delhi, India, to estimate the costs of illness for typhoid fever cases. 98 culture-positive typhoid, 31 culture-positive paratyphoid, and 94 culture-negative cases with clinical typhoid syndrome were identified. The estimates of costs of illness were based on data collected through weekly interviews conducted at home for 3 months following diagnosis. Private costs included the sum of direct medical, direct non-medical and indirect costs. Non-patient (public) costs included costs of outpatient visits, hospitalizations, laboratory tests and medicines provided free of charge to the families. The mean cost per episode of blood culture-confirmed typhoid fever was Rs 3597 (SD 5833); $1 is equal to Rs 35.5. Hospitalization increased the costs several fold (Rs 18 131, SD 11 218; P<0.0001). The private and non-patient costs of illness were similar (Rs 1732 (SD 1589) and Rs 1865 (SD 5154), respectively; P=0.8095). The total private and non-patient ex-ante costs, i.e. expected annual losses for each individual, were higher for children aged 2-5 years (Rs 154) than for those aged 5-19 years (Rs 32), 0-2 years (Rs 25) and 19-40 years (Rs 2). This study highlights the need for affordable typhoid vaccines effective for children aged 2-5 years. The currently available Vi vaccine is affordable, but is unlikely to be effective in the first 2 years of life. It is suggested that ways must be found to make Vi-conjugate vaccine effective for 0- to 2-year-old children available in Developing Countries.