The Economic Burden Attributable to a Child’s Inpatient Admission for Diarrheal Disease in Rwanda

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$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

Estimated economic burden of non-bloody diarrhea hospitalizations from 2008–2011 and in 2014 in US$ and percentage difference in the economic burden compared to 2014 burden.

<p>Estimated economic burden of non-bloody diarrhea hospitalizations from 2008–2011 and in 2014 in US$ and percentage difference in the economic burden compared to 2014 burden.</p

Direct medical costs for the diarrhea illness in US$: mean ± standard deviation and median costs in parenthesis.

<p>Direct medical costs for the diarrhea illness in US$: mean ± standard deviation and median costs in parenthesis.</p

Patient and household characteristics.

<p>Patient and household characteristics.</p

Direct non-medical costs and lost income in US$: mean ± standard deviation and median costs in parenthesis.

<p>Direct non-medical costs and lost income in US$: mean ± standard deviation and median costs in parenthesis.</p

Unit costs in US$ for selected drugs, consumables and medical service used during a diarrhea admission based on the Rwanda tariff schedule.

<p>Unit costs in US$ for selected drugs, consumables and medical service used during a diarrhea admission based on the Rwanda tariff schedule.</p