# Acute and Postacute Health Care Utilization and Costs After Dengue Infection: A Population-Based Cohort Study

## TL;DR

This study finds that dengue infection is linked to higher healthcare use and costs, both immediately after infection and in the months that follow.

## Contribution

The study quantifies the increased risk and cost of healthcare utilization following dengue infection using a large population-based cohort.

## Key findings

- Dengue patients had higher emergency department visits, inpatient admissions, and inpatient costs during acute and postacute periods.
- Dengue patients had 12-fold higher inpatient visit rates and 16-fold longer hospital stays in the acute phase.
- Postacute period showed 1.157-fold higher inpatient visit rates and 1.339-fold longer hospital stays for dengue patients.

## Abstract

Emerging evidence suggests that postacute sequelae may arise following dengue infection. There has been no quantification of the risk and burden of acute and postacute health care utilization and cost due to dengue.

We utilized national notification databases from Singapore to construct cohorts of adults first infected with dengue. We compared 55 870 dengue cases with 3 072 309 population-based controls. We estimate excess risks, rates, and burdens of any all-cause inpatient hospital utilization, length of stay in inpatient settings or number of unique hospital inpatient admissions, any all-cause intensive care unit utilization, length of stay in the intensive care unit (ICU) or number of unique ICU admissions, any all-cause emergency department utilization and total number of unique emergency department visits, and any hospitalization costs incurred and excess total hospitalization costs incurred by contrasting dengue patients with population-based controls 0–30 days and 31–300 days following infection.

Dengue patients had elevated risk of emergency department visits, inpatient admissions, and incurring any inpatient costs across the acute and postacute periods. Among patients who had any inpatient admissions, dengue patients were associated with 11.938-fold (95% CI, 10.308–14.179) higher rates of unique inpatient visits, 15.852-fold (95% CI, 11.868–23.861) longer lengths of stay, 1.157-fold (95% CI, 1.123–1.192) higher rates of unique inpatient visits, and 1.339-fold (95% CI, 1.291–1.39) longer lengths of stay in the postacute period. Over the study period, the majority of excess health care costs were estimated to occur in the acute phase (US$21 363 084) compared with the postacute period (US$687 032).

There is increased excess risk and rates of health care utilization in the 300 days post-dengue infection when compared with contemporary population-based controls.

Graphical AbstractThis graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/acute-and-post-acute-healthcare-utilization-and-costs-after-dengue-infection-a-population-based-cohort-study-4e39ca6c-de66-4b55-aa31-4188b0165a2c?utm_campaign=tidbitlinkshare&utm_source=ITP

This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/acute-and-post-acute-healthcare-utilization-and-costs-after-dengue-infection-a-population-based-cohort-study-4e39ca6c-de66-4b55-aa31-4188b0165a2c?utm_campaign=tidbitlinkshare&utm_source=ITP

In this population-based cohort study, 30-days post recovery, among dengue patients and population-based controls who had any inpatient admissions, dengue patients were associated to an almost 12-fold higher rates of inpatient visits and 16-fold longer lengths of stay. In the 30-300 days following recovery, dengue patients had 1.157-fold higher rates of unique inpatient visits and 1.339-fold longer lengths of stay in the post-acute period.