Cost-effectiveness of a trap to capture the dengue adult vector in the context of the Public Health System in Brazil

1. Cost-effectiveness of a trap to
capture the dengue adult vector in
the context of the Public Health
System in Brazil
Authors: Fabiana Raynal Floriano; Luis Eugenio Portela; Sebastião Loureiro;
Martha Teixeira; Gimena M. Santos; Vanessa C.G.S. Morato; Maria da Glória
Teixeira; Patrícia Barber; Naomar de Almeida Filho

2. Figure 2: Dengue incidence between 2001 and 2011 in Salvador, Bahia and Brazil.
Introduction
Figure 1: Distribution of Dengue around the world, 2005.
Source: http://www2.datasus.gov.br/DATASUS/index.php
Source: http://www.cdc.gov/ncidod/dvbid/dengue/map-distribution-2005.htm

3. Introduction
 Dengue’s impact on health services, society and
country’s economy.
 National Dengue Control Plan (PNCD) (Ministry of
Health, 2002).
 Strategies to eliminate the Aedes aegypti with
controversial efficacy new technologies are being
developed and applied.
 Mosquitrap - letal (Intelligent Monitoring System)
Source:
http://www.ecovec.com/
midengue.php

4. Objective
 To estimate the cost-effectiveness of:
 Trap to capture the dengue adult vector+
Usual program (Intervention area)
 Usual program of dengue control (Control
area).

5. Materials and Method
 Time horizon: 2011;
 Public Health System perspective: direct medical
costs
 Population: children aged 0-14 years
 Epidemiological indicators:
 incidence;
 percentage distribution of dengue according to
dengue severity.
 Trap Effectiveness measure: Reduction of the
dengue incidence

6. Materials and Method - Costs
Health Care Cost
 All stages of the disease progression (MH, 2011)
 Direct medical costs: diagnostic tests; drugs; service:
professional fees and hospitalization

7. Materials and Method - Costs
Health Care Cost
 All stages of the disease progression (MH, 2011)
 Direct medical costs: diagnostic tests; drugs; service:
professional fees and hospitalization
Technology Cost
 3,232 traps
 deployment service
 monitoring and maintenance services: materials and
training

8. Materials and Method - Costs
Health Care Cost
 All stages of the disease progression (MH, 2011)
 Direct medical costs: diagnostic tests; drugs; service:
professional fees and hospitalization
Technology Cost
 3,232 traps
 deployment service
 monitoring and maintenance services: materials and
training
Total Cost
 Control Area: Health Care Cost
 Intervention Area: Health Care Cost + Technology
Cost

9. Materials and Method
Effectiveness
 Prevented dengue cases
Cost-Effectiveness
 Decision tree analytical model
Sensitivity Analysis
 Effectiveness: highest and lowest dengue incidence,
in the last five years, in Salvador

10. Results
Table 1: Total cost (USD) of dengue treatment, according to risk
classification, Salvador, Bahia, Brazil, 2011.
Costs of Health Care Group A (%) Group B (%) Group C (%) Group D (%)
Direct medical costs
Diagnostic tests 201.12 (86.67) 487.93 (90.12) 3,478.98(58.37) 4,911.45 (53.36)
Professional fees
11.78 (5.07) 27.26 (5.04) 2,445.69 (41.04) 4,030.96 (43.79)
and Hospitalization
Drugs 19.17 (8.26) 26.20 (4.84) 35.13 (0.59) 262.65 (2.85)
Total Cost of Treatment 232.07 (100) 541.40 (100) 5,959.79 (100) 9,205.06 (100)

11. Results
Table 2: Dengue cases, total cost and cost average case (USD), in the
intervention and control areas, Salvador, Bahia, Brazil, 2011.
Difference Between
Itens Intervention Area Control Area
Areas
Incidence 12.73% 14.38% -1.65
Dengue Case 69,533 78,545 -9,012
Treatment Cost 32,773,670.58 37,021,632.60 - 4,247,962.02
Technology Cost 2,770,471.25 0.00 2,770,471.25
Total Cost 35,544,141.83 37,021,632.60 - 1,477,490.77
Cost Average Case 511.19 471.34 39.85

12. Results
Table 3: Cost-Effectiveness (C/E), Incremental Cost-Effectiveness Ratio
(ICER) and Sensitivity Analysis of control and intervention
areas, Salvador, Bahia, Brazil, 2011.
Cost Effectiveness Effectiveness
Areas C/E Cost ICER
(C) (E) (Prevented Cases)
Intervention 35,544,141.83 69,533 511.19
- 1,477,490.76 -9,012 163.94
Control 37,021,632.60 78,545 471.34
Sensitivity Analysis
Highest Incidence
Intervention 57,118,639.83 115,305 495.37
- 4,283,720.22 -14,966 286.23
Control 61,402,360.04 130,217 471.54
Lowest Incidence
Intervention 8,357,184.93 11,853 705.07
2,023,859.75 -1,584 -1,277.68
Control 6,333,325.19 13,437 471.34

13. Conclusion
 Trap was effective
 Control area was dominated
 However, the sensitivity analysis showed that
the ICER varied according to the population’s
disease incidence
 Health managers must consider dengue
incidence, before incorporating the trap

14. Bibliographical References
1. BRASIL. Ministério da Saúde. Banco de Dados do Sistema Único de
Saúde – DATASUS. http://www2.datasus.gov.br/DATASUS/index.php.
2. BRASIL. Ministério da Saúde. Programa Nacional de Controle da
Dengue. MS, FUNASA. Brasília: Ministério da Saúde, 2002. 34p.
3. SIGTAP. http://sigtap.datasus.gov.br/tabela-unificada/app/sec/inicio.jsp.
4. Banco de Preços do Ministério da Saúde.
http://bps.saude.gov.br/login.cfm.
5. BRASIL. Ministério da Saúde. Dengue: diagnóstico e manejo clínico:
criança. MS, Secretaria de Vigilância em Saúde, Departamento de
Vigilância Epidemiológica. – Brasília: Ministério da Saúde, 2011. 52p.
6. BRASIL. Instituto Brasileiro de Geografia e Estatística – IBGE.
http://www.ibge.gov.br/home/.
7. BRASIL. Banco Central. Taxa de Câmbio.
http://www4.bcb.gov.br/pec/conversao/conversao.asp.
8. ECOVEC. M.I. Dengue. http://www.ecovec.com/midengue.php.

15. Contacts:
fabianaraynal@hotmail.com
Web site:
http://www.inct-citecs.ufba.br
http://www.isc.ufba.br/index.php
http://www.pbct.inweb.org.br/pbct/