Cost evaluation of typhoid fever in Indonesia

Abstract

Typhoid fever is endemic in Indonesia. Epidemiologic studies and household surveys show that the incidence of this disease in Indonesia is between 358-810/100,000 population/year. The majority of these patients (estimated 90%) are managed as outpatients and receive antibiotic treatment for approximately 2 weeks, depending upon type of antibiotic used. More severe cases require hospitalization for about 5 days - 2 weeks. Between 3-5% of cases develop complication(s). The mortality of this disease is between 0.6-2%. Since the total population of Indonesia is 200 million, it is estimated there are 1.08 million new cases of typhoid fever in Indonesia every year. Outpatient treatment cost for a mild typhoid fever case is estimated at $ 50-150.-. Hospitalization cost for uncomplicated case is about $ 100-500.-; a complicated case would cost $ 250.- or more. These figures depend upon the choice of antibiotic used (chloramphenicol vs. quinolone or 3rd generation cephalosporin), patients ability to pay, choice of hospital (government vs. private), patients response to the treatment, and doctor s preference for time of discharge (immediately vs. several days after defervescence). Most typhoid fever patients are unable to attend work or school for an average of 20-30 days. In addition, usually 1 or 2 other family members activities are disrupted to care for the patient (for both in and outpatient). These along with the special diet, transport etc. add to the family’s burden and loss of income. It is estimated that treatment of typhoid fever costs almost US $ 60 million and there is also about $ 60 million loss of income. Mortality of this disease is estimated at 6,500-20,000 per year in Indonesia. A vaccine that is simple to administer, has good efficacy, high compliance, and is inexpensive with low side effects with effective public health education, could reduce this disease burden.