The Economic Burden Attributable to a Child's Inpatient Admission for Diarrheal Disease in Rwanda
Fidele Ngabo1,2, Mercy Mvundura3, Lauren Gazley4
1Université Libre de Bruxelles, Ecole de Santé Publique, Brussels, Belgium.
Insights
Diarrhea hospitalizations in children under five impose a significant economic burden, primarily on households, particularly those with low incomes. This highlights the need for interventions like the rotavirus vaccine.
Area of Science:
- Public Health
- Health Economics
- Pediatrics
Background:
- Diarrhea is a major cause of illness and death in young children globally.
- Hospitalization for diarrhea strains healthcare systems and household finances.
- Estimating the economic impact of diarrhea hospitalizations is crucial for policy decisions.
Purpose of the Study:
- To quantify the economic burden of diarrhea hospitalizations in children under five in Rwanda.
- To inform decision-making regarding interventions, such as rotavirus vaccine introduction.
Main Methods:
- A prospective costing study analyzed medical records and hospital bills from three hospitals.
- Resource utilization, including length of stay and direct medical costs, was calculated.
- Household costs, including transport and lost income, were assessed through caregiver interviews.
Main Results:
- The total economic burden per hospitalization was $101, with households bearing 65% of the cost.
- For the lowest income quintile, household costs equated to 110% of monthly income.
- The annual economic burden in Rwanda ranged from $1.3 to $1.7 million before rotavirus vaccine introduction.
Conclusions:
- Households disproportionately bear the economic impact of childhood diarrhea hospitalizations.
- The financial strain is particularly severe for low-income households.
- Reducing diarrhea morbidity through interventions can alleviate significant economic pressure.
Background:
Diarrhea is one of the leading causes of childhood morbidity and mortality. Hospitalization for diarrhea can pose a significant burden to health systems and households. The objective of this study was to estimate the economic burden attributable to hospitalization for diarrhea among children less than five years old in Rwanda. These data can be used by decision-makers to assess the impact of interventions that reduce diarrhea morbidity, including rotavirus vaccine introduction.
Methods:
This was a prospective costing study where medical records and hospital bills for children admitted with diarrhea at three hospitals were collected to estimate resource use and costs. Hospital length of stay was calculated from medical records. Costs incurred during the hospitalization were abstracted from the hospital bills. Interviews with the child's caregivers provided data to estimate household costs which included transport costs and lost income. The portion of medical costs borne by insurance and household were reported separately. Annual economic burden before and after rotavirus vaccine introduction was estimated by multiplying the reported number of diarrhea hospitalizations in public health centers and district hospitals by the estimated economic burden per hospitalization. All costs are presented in 2014 US$.
Results:
Costs for 203 children were analyzed. Approximately 93% of the children had health insurance coverage. Average hospital length of stay was 5.3 ± 3.9 days. Average medical costs for each child for the illness resulting in a hospitalization were $44.22 ± $23.74 and the total economic burden was $101, of which 65% was borne by the household. For households in the lowest income quintile, the household costs were 110% of their monthly income. The annual economic burden to Rwanda attributable to diarrhea hospitalizations ranged from $1.3 million to $1.7 million before rotavirus vaccine introduction.
Conclusion:
Households often bear the largest share of the economic burden attributable to diarrhea hospitalization and the burden can be substantial, especially for households in the lowest income quintile.
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