Acute and Postacute Health Care Utilization and Costs After Dengue Infection: A Population-Based Cohort Study

Emerging evidence suggests that postacute sequelae may arise following dengue infection. There has been no quantification of the risk and burden of acute and postacute health care utilization and cost due to dengue.

We utilized national notification databases from Singapore to construct cohorts of adults first infected with dengue. We compared 55 870 dengue cases with 3 072 309 population-based controls. We estimate excess risks, rates, and burdens of any all-cause inpatient hospital utilization, length of stay in inpatient settings or number of unique hospital inpatient admissions, any all-cause intensive care unit utilization, length of stay in the intensive care unit (ICU) or number of unique ICU admissions, any all-cause emergency department utilization and total number of unique emergency department visits, and any hospitalization costs incurred and excess total hospitalization costs incurred by contrasting dengue patients with population-based controls 0-30 days and 31-300 days following infection.

Dengue patients had elevated risk of emergency department visits, inpatient admissions, and incurring any inpatient costs across the acute and postacute periods. Among patients who had any inpatient admissions, dengue patients were associated with 11.938-fold (95% CI, 10.308-14.179) higher rates of unique inpatient visits, 15.852-fold (95% CI, 11.868-23.861) longer lengths of stay, 1.157-fold (95% CI, 1.123-1.192) higher rates of unique inpatient visits, and 1.339-fold (95% CI, 1.291-1.39) longer lengths of stay in the postacute period. Over the study period, the majority of excess health care costs were estimated to occur in the acute phase (US$21 363 084) compared with the postacute period (US$687 032).

There is increased excess risk and rates of health care utilization in the 300 days post-dengue infection when compared with contemporary population-based controls.