THE COST OF DENGUE SHOCK AND SEPTIC SHOCK IN VIETNAM

Abstract

Intro: Dengue shock (DS) and septic shock (SS) are the two most common infectious causes of shock in Vietnam. Little is known about the cost of an episode of either of these critical illnesses, from the perspective of the patient/their household. We aimed to describe the direct medical, non-medical and productivity costs associated with DS and SS. Methods: Adults with SS and DS were recruited to a prospective observational study at the Hospital for Tropical Diseases, in Ho Chi Minh City, Vietnam from 2019-2021. We collected hospital bills, insurance status and percentage copay from hospital records, and conducted a detailed economic questionnaire with patients at hospital discharge, 1,3 and 6 months later. The proportion of patients incurring Catastrophic Health Expenditure (CHE) and Catastrophic Costs were calculated. Findings: The analysis included 127 patients with DS, and 35 patients with SS. 18.9% and 71.43% patients with DS and SS respectively incurred CHE (threshold at >10% annual household income). Having healthcare insurance offered slight protection against incurring CHE for patients with DS, but paradoxically the proportion of patients with CHE was higher in insured versus uninsured patients with SS. When non-medical costs and productivity costs were considered, the cost of illness (versus the hospital bill alone) increased by a factor of 6.37 and 6.73 for DS and SS respectively. Conclusion: The true cost of DS and SS is several times higher than the hospital bill; productivity costs must be counted for patients with critical illness in LMIC. It is vital that financial protection is put in place for patients surviving critical illness in LMIC, and for families of non-survivors. As critical care capabilities expand in Vietnam, insurance reimbursement schedules must adapt to cover the high-cost interventions that patients with DS and SS require.