14
UWI TODAY
– SUNDAY 1ST FEBRUARY, 2015
Do Costs Matter?
Within the last six months, everyone in Trinidad and
Tobago (and perhaps in the wider Caribbean) seems to
know someone who has or had been affected or afflicted
by the Chikungunya virus. Yet, while there is much
information and opinion about the number of cases
(actual and suspected), whether all cases are the result
of ChikV or some other virus and whether ‘de govament’
is doing enough to curb or cure the disease, there is
much less information on the numbers pertaining to
the costs of the disease. So really, do costs matter? And
who’s counting?
The experts tell us that in relation to ChikV (or any other
disease), there are four categories of costs we should
consider and count:
Public Health Costs:
what the State is doing or is
required to do in terms of disease prevention, treatment
and mitigation measures. These include additional costs
(over and above budgeted amounts) at the national/
community level for health education messages,
equipment/material/personnel for spraying and fogging,
public health inspections and screening at the ports of
entry.
At another level, there are additional costs incurred
in actual treatment of cases/sickened persons at the
public health institutions (clinics and hospitals) such as
supplies, medications, screening, lab tests, hospitalisation,
rehabilitation.
Individual or Household Costs:
what are sickened
individuals or their relatives paying mostly to private
doctors ormedical centres todiagnose, treat, monitor and
manage their condition. These include direct, immediate
and ongoing costs of consultation, diagnosis, intravenous
drips, injections, medications, gels/rubs, physiotherapy
pertaining to managing the disease itself and to some
extent any underlying conditions which may have flared
up as a result of ChikV or which may have increased the
severity of the impact of ChikV.
Indirect costs include the cost of travel for treatment,
non-medical items bought to assist in managing the
condition such as insect repellent (DEET), special foods,
supplements, bed nets, ‘zappers’ and mosquito control
supplies.
While most of these costs are relatively easy to obtain
and calculate, there is more difficulty in measuring
the immediate and longer term cost of ‘pain, suffering,
depression, social dislocation and loss of quality of life’
of ChikV patients.
Business Costs:
What are the production losses (both of
goods and services) incurred by businesses as a result of
absent workers who are sickened with ChikV or who are
relatives of sickened persons and are forced to stay away
from work to provide care. Production losses can also
result when the sickened persons are‘present’but unable
to function at full capacity. In some of these cases, costs
could include overtime payments having to be made to
non-sick workers to cover for sick persons or reduced
availability-timeliness-quality of services.
Business costs also include the additional payments being
made by the National Insurance Board to cover ‘sickness’
and ‘disability’ claims resulting from ChikV as well as
increases in health insurance premiums resulting from
more medical claims.
National Development Costs:
What are the lost
or deferred expected benefits as a result of current
programmes, projects having to be curtailed, diluted or
displaced because ChikV has become the new priority?
These include economic losses such as cancellation or
reduction in tourismvisits (travel advisories issued by the
Public Health Agency of Canada on August 18, 2014 and
the Centers for Disease Control in the US on November
6, 2014 on ChikV in the Caribbean, Central and South
America), cancellation of social events (entertainment
and sports) and ‘education’ losses for sickened school
children.
Inother words, what are the‘opportunity costs’or‘benefits
foregone’ because of the negative impact of ChikV in
terms of the shiftingof resources fromother development
and social pursuits to combat the disease?
Some Data on Costs
So far, no Caribbean country has fully computed the
financial and economic costs of ChikV. From the existing
‘patchy’ dataset, some broad trends may be detected.
In Jamaica, theMinistry of Health reported having to find
an additional J$12million to combat the disease (Jamaica
Observer, August 25, 2014). This was deemed inadequate
and an additional J$350 million was allocated to control
and mitigation efforts in October (Jamaica Observer,
October 9, 2014).
In Trinidad and Tobago at the household and individual
level, theaverage cost of the consultation, drips, injections,
and prescription froma doctor isTT$600. For consultation
with a specialist, the cost will be approximately TT$400.
Standard medication costs are TT$75 per week for
Panadeine tablets (4 per day at about TT$2.50 each);
TT$13.95 for Divon gel muscle rub and/or TT$18.95 for
Arthritis plus 2 Cream.
Among Caribbean countries, as reported in the Jamaica
Gleaner of October 16, 2014, Jamaica seems to be in
the forefront of actually trying to measure the business
costs of ChikV. In a sample survey of 101 of its member
companies, the JamaicaManufacturers Association found
that:
81% companies reported having workers affected by
ChikV; Affectedworkers stayed off the jobs for an average
of four days; At seven hours per work-day, a total of 35,072
man-hours were lost due to absenteeism.
Picking up
the tab
What a virus can cost
In another estimate, the CEO of the Private Sector
Organisation of Jamaica (PSOJ) indicated that more
than 13 million human-hours had been lost due to
ChikV related absenteeism resulting in financial losses of
approximately J$6 billion (US$60 million) during 2014.
At other levels, school attendance has fallen and even
some court cases have been postponed in Jamaica
because of sick magistrates or lawyers or court staff
(Jamaica Observer, October 20, 2014).
Given the prevalence of the condition with population
figures of 30% having or having had the virus, and
the advice provided by health officials (ministries of
health, the Caribbean Public Health Agency and the Pan
AmericanHealthOrganisation) that ChikV, having entered
the Caribbean, is ‘here to stay’ and ‘has not reached its
peak yet’ thus making all of us ‘susceptible’, then costs
matter and costing the impact of the disease should be
a priority.
(
Editor’s note:
Attempts to get figures from the Principal Medical
Officer at the Ministry of Health on ChikV related expenditure were
unsuccessful.)
What it
CostsYou
Painkillers
Most pharmacies checked report that
Panadeine
has been the top seller, probably based on the
Health Minister’s advice to take it. Each Panadeine
tablet is a combination of paracetamol and codeine
sulphate, targeting not only the actual site of the
pain but also the pain sensors in the brain helping
to dull sharp pain. It goes at 10 at $25 per card. At 4
recommended doses daily (2 every 4 to 6 hours) it
would be just over 5 cards weekly. $125 •
Zerodol-P
(aceclofenac) $2.65 each.
Aceclofenac
is a non-
steroidal anti-inflammatory drug. It is used for
the relief of pain and inflammation in rheumatoid
arthritis, osteoarthritis and ankylosing spondylitis. •
Flamar-MX
($1 each) •
Auroflam-MX
($1 each)
•
Nise
$1.50 each
Muscle rubs
Divon gel
, at the lower end of the price range
is $13.95 for the smallest size.
Voltaren
is about three times more expensive.
Arthritis Plus cream
: $10.95 for the smallest size
Prednisolone
: 25 cents each (steroids)
Doctor’s visit
: GP $200
Specialist
$400
Blood test
$200
Corticosteroid injections
$200 each
(done on sites like joints)
(compiled by Vaneisa Baksh)
The Centre for Health Economics
of The UWI has begun
tracking the economic implications of the Chikungunya virus, and
shares some of the factors that are considered when measuring
the cost to a country when epidemics such as this hits.
The
Chikungunya
Effect
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