ESTIMATION OF THE SOCIAL AND ECONOMIC BURDENS OF DENGUE AND ZIKA VIRUS IN BRAZIL: A PUBLIC POLICY TOOL
Rapid and unplanned urbanization, global trade and travel, and environmental changes have created a world extraordinarily well suited to Aedes aegypti mosquitoes and thus to transmission of dengue virus, chikungunya, and Zika Virus (ZIKV), particularly in tropical and subtropical regions. Currently, more than half of the global population lives in areas with risk of dengue transmission, and ZIKV is spreading fast. With no specific drugs for treatment and with vector-control efforts unable to curb disease expansion, the burden is daunting.The epidemiological characteristics of dengue and ZIKV result in considerable social and economic burdens [1-4]. Quantifying these burdens is critical for policy makers to set priorities, allocate resources, select control/prevention strategies, and evaluate the cost-effectiveness of interventions [5,6]. Coupled with burden estimates, mathematical models can be used to simulate the outcomes of different combinations of interventions, aiding decision making.The economic and social burden can be conceptualized in terms of the costs imposed on individuals and society by actual and threatened dengue and ZIKV infections, including costs directly or indirectly associated with the diagnosis, treatment, outcome (e.g., death, neurological consequences), and prevention. We proposed a framework  to summarize these costs into four domains?illness, surveillance and reporting, control and preventive actions, and outbreak management ?identifying the different stakeholders that incur these costs?the government or a private insurer, the individual and/or the household, and society as a whole. Here, outbreak refers to disease introduction in areas with no previously reported cases or a significant increase in the number of cases (two standard deviations above the mean of the past 3-5 years) . Decomposing the cost estimate by who bears the burden sensitizes both the government, which must identify the best control strategies; the community, who must engage in control and preventive efforts to avoid proliferation of mosquito-breeding habitats; and the private sector, who may get a significant return on their own business by investing in disease control. Also, considering a time series of data is crucial to capture the common cyclical pattern of transmission, facilitating the calculation of the burden both during endemic and epidemic periods [5,6,9,10]. Failure to obtain data for multiple years is likely to over- or underestimate the burden, depending on the epidemiological characteristics of the year(s) analyzed.Few studies have addressed the burden of dengue in Brazil, none with national representation detailed by subnational-level units [11-13], and there are no estimations of the burden of ZIKV. As a result, there is no comprehensive analysis of burden and thus no detailed simulation of scenarios of interventions that can aid the Ministry of Health in choosing and prioritizing strategies to control the diseases, and no mechanism to advocate for support from other sectors (government and private). In this context, the government remains constrained to traditional control policies, despite their limited effectiveness.Here we propose to fill in this crucial gap. Utilizing a comprehensive framework of types of cost , and a societal perspective , we will estimate the social and economic burdens of dengue and ZIKV in Brazil, detailed by state level, for a 5-year period (at minimum). We will leverage the large amount of data freely available through governmental agencies, and the fact that additional data can be obtained through a data access law instituted by Brazil in 2011 . When data are not at all available, we will make assumptions based on literature review or expert opinion.
Mônica Viegas Andrade - Integrante / JULIA CALAZANS - Integrante / LUCAS CARVALHO - Integrante / MARCIA CASTRO - Coordenador.