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.
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:
a) 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.
b) Individual or Household Costs: what are sickened individuals or their relatives paying mostly to private doctors or medical centres to diagnose, 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 .
c) 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.
d) 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 tourism visits (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.
In other words, what are the ‘opportunity costs’ or ‘benefits foregone’ because of the negative impact of ChikV in terms of the shifting of resources from other 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, the Ministry of Health reported having to find an additional J$12 million 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, the average cost of the consultation, drips, injections, and prescription from a doctor is TT$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 Jamaica Manufacturers Association found that:
- 81% companies reported having workers affected by ChikV;
- Affected workers 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.
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 American Health Organisation) 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 costs to you
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) |
