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Leptospirosis is a worldwide zoonosis with global importance. Developing countries carry the major burden of the disease, with half a million cases reported yearly and a mortality rate ranging from 5 to 10%. There are 1.03 million cases of leptospirosis worldwide each year and 58,900 deaths, which corresponds to an estimated 2.9 million disability-adjusted life years per annum, including 2.8 million years of life lost due to premature death.
In the same time, the economic impact of leptospirosis on the public health is not well studied. There are only few studies on this aspect but neither hospital costs per diem treatment or costs for different according to severity cases had been estimated.
In a recent paper by author Dr G. I. Gancheva, the cost effectiveness of predicting severity in leptospirosis had been discussed. A simple step-by-step method for calculation of hospital costs for treatment of leptospirosis cases had been suggested. The crucial point in this method is assessment of severity of each of leptospirosis cases at hospital admission according to previously created definitions. The other important step is an estimation of mean course of hospital treatment in different form of severity.
Mean hospital financial costs per diem for mild, moderate and severe leptospirosis (in BGL = 1.84 USD/ to November 23rd 2016)
“The data for mean hospital course of treatment in different severity are not in result of multiplication of the costs per diem to the number of days in the hospital. The results are obtained by calculation of the prices of really performed service, investigations and administered drugs at each form of severity. This approach eliminates the bias caused by formal multiplication of the costs in first day (higher than the lasts) to the number of days in the hospital,” Dr Gancheva said.
The analysis of the data for total hospital costs of mild, moderate and severe leptospirosis had revealed respective ratio 1 to 1.78 to 6.79. By consequent analysis of the costs, it had been found that the structure of the costs in severe cases included 37% for service and 37% for treatment. The analysis of the costs for treatment revealed that the half of costs for treatment in severe cases had been spent on dialysis. As the author mentioned, “this fact shows two aspects of the dialysis – medical and economical. From medical view point, the early performed dialysis in severe leptospirosis decreases the risk for lethal outcome and neutralizes increased risk of procedure augmented the risk of hemorrhages caused by the leptospirosis per se. Acute renal failure is a crucial feature of severe leptospirosis and most important factor for life-threatening complications such as lung edema and brain edema. Comparative analysis of deceased and survived severe cases of leptospirosis with and without dialysis revealed that dialysis in severe leptospirosis markedly decreases serum creatinine level. The early initiated dialysis has favorable impact – reduces the risk for life-threatening complications (brain edema and lung edema) and decreases mortality. From economic view point, the early performed dialysis could be improving the patient’s condition and could be decreasing the number of dialyzing procedures and their costs. The predicting of severe course in case of leptospirosis based on prognostic criteria has a great significance for early initiation of intensive treatment and dialysis.”
Leptospirosis is a social-ecological problem, which often occurs in the context of social inequity. Therefore, there is a critical need to evaluate and address the investment case for interventions that target the underlying environmental conditions and infrastructure deficiencies, such as open sewers in urban slum communities, in order to make sustainable progress against this neglected disease. Additional work is needed to quantify the economic burden of leptospirosis. The recent paper is a contribution in calculation of hospital costs for treatment of leptospirosis. In the same time, Dr Gancheva considers that the favorable outcome of disease has priority over economic aspect. Correct management of the cases of leptospirosis including early prognosis improves the chance of severe leptospirosis cases to survive.
Dr G. I. Gancheva, Associate Professor in Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine, Faculty of Public Health, Medical University-Pleven, Bulgaria
A paper about the study appeared recently in International Journal of Health Economics and Policy.