USING DISABILITY-ADJUSTED LIFE YEARS TO ASSESS THE ECONOMIC-IMPACT OFDENGUE IN PUERTO-RICO - 1984-1994

This study presents the disability-adjusted life years (DALYs), a non- monetary economic measure of impact, lost to dengue in Puerto Rico for the period 1984-1994. Data on the number of reported cases, cases wit h hemorrhagic manifestations, hospitalizations, and deaths were obtain ed from a surveillance system maintained at the Dengue Branch, Divisio n of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention (San Juan, PR). The reported cases were divided into two a ge groups (0-15 years old and > 15 years old), and then multiplied by predetermined factors (10 for 0-15 years; 27 for > 15 years) to allow for age-related under-reporting of cases. Severity of dengue was model ed by classifying cases into three groups: dengue fever, dengue with s evere manifestations, and hospitalized cases. Each group was assigned a different number of days lost because of dengue-related disability. Dengue caused an average of 658 DALYs per year per million population (SE = 114, range = 145-1,519). A multivariate sensitivity analysis, wh ich simultaneously altered the values of six input variables, produced a mean of 580 DALYs/year/million population, with a maximum average o f 1,021 DALYs/year/million population, and a maximum, single-year esti mate for 1994 of 2,153 DALYs/million population. The most important in put was the number of days lost to classic dengue. The DALYs/year/mill ion population lost to dengue in Puerto Rico are much greater than pre vious estimates concerning the impact of dengue hemorrhagic fever alon e. The loss to dengue is similar to the losses per million population in the Latin American and Caribbean region attributed to any of the fo llowing diseases or disease clusters; the childhood cluster (polio, me asles, pertussis, diphtheria, tetanus), meningitis, hepatitis, or mala ria. The loss is also of the same order of magnitude as any one of the following: tuberculosis, sexually transmitted diseases (excluding hum an immunodeficiency virus), tropical cluster (e.g., Chagas' disease, l eishmaniasis), or intestinal helminths. The results objectively sugges t that when governments and international funding agencies allocate re sources for research and control, dengue should be given a priority eq ual to many other infectious diseases that are generally considered mo re important.