# Estimating dengue disease and economic burden to inform municipal-level policymakers: Method for a pragmatic city-level observational cohort study

## TL;DR

This paper introduces a streamlined method to estimate dengue disease and economic burden at the municipal level to help local policymakers make informed decisions.

## Contribution

A new pragmatic observational cohort study method is developed to quickly and accurately estimate dengue burden at the city level.

## Key findings

- The method involves enrolling 100 confirmed dengue patients to assess disease and economic burden.
- The approach captures acute and chronic effects, including psychological impacts like presenteeism.
- The method was successfully demonstrated in Semarang, Indonesia, a city of 1.8 million people.

## Abstract

Recent trials have confirmed the effectiveness of promising dengue control technologies – two vaccines, and
Wolbachia. These would generally be applied at the municipal level. To balance health needs and resource constraints, local officials need affordable, timely, and accurate data. Building on our previous work in Mexico, Indonesia, and Thailand, we developed a streamlined prospective method to estimate dengue burden at the municipal level quickly, accurately, and efficiently.

The method entails enrolling and repeatedly interviewing 100 patients with laboratory-confirmed dengue. They will be selected after screening and testing about 1,000 patients with clinical dengue. The method will capture both acute and chronic effects relating to disease, economic burden, and psychological impacts (presenteeism). The total time requirements are 1.5 years, comprised of 0.25 years for planning and approvals, 1 year for data collection (a full dengue cycle), and 0 .25 years for data cleaning and analysis. A collaboration with municipal and academic colleagues in the city of Semarang, Central Java, Indonesia shows how the method could be readily applied in Indonesia’s eighth largest city (population 1.8 million).

Many surveillance studies gather only information on numbers of cases. This proposed method will provide a comprehensive picture of the dengue burden to the health system, payers, and households at the local level.