Cost-Of-Illness Study For Dengue Disease: A Quantile Regression Analysis (A Case Study Of District Nowshera)

Abstract

This study examines the economic burden of dengue fever in Nowshera District, a region highly vulnerable to climate change due to intensified monsoon rainfall and recurrent flooding. Data was collected from 322 dengue patients through a structured questionnaire, and a bottom-up micro-costing approach was applied to conduct a cost-of-illness analysis. The study quantified both direct costs (medical and non-medical expenses) and indirect costs (income loss, productivity decline, and related expenditures). Quantile regression analysis revealed heterogeneous effects across cost distributions. At the 0.25 quantile, being male increased direct costs by PKR 0.017 and rural residency added PKR 0.003, while treatment in public hospitals reduced direct costs by PKR 0.060. For indirect costs at this quantile, being male increased expenditures by PKR 0.46, and public hospital treatment was associated with a PKR 0.468 rise. At the 0.75 quantile, the effect of male gender on direct costs diminished to PKR 0.004, rural residency reduced direct costs by PKR 0.040, and public hospital treatment continued to lower direct costs by PKR 0.073. However, indirect costs at this higher quantile still increased by PKR 0.217 for those treated in public hospitals. Overall, the findings highlight the significant economic burden posed by dengue fever in climate-sensitive regions, with notable variations across socio-demographic groups and healthcare settings. The results underscore the need for climate-adaptive, cost-effective public health policies in Nowshera and similar vulnerable districts of Pakistan.