{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T21:05:02Z","timestamp":1772571902518,"version":"3.50.1"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2021,10,8]],"date-time":"2021-10-08T00:00:00Z","timestamp":1633651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009826","name":"University of Colombo","doi-asserted-by":"publisher","award":["AP \/3\/2\/2017\/CG \/25"],"award-info":[{"award-number":["AP \/3\/2\/2017\/CG \/25"]}],"id":[{"id":"10.13039\/501100009826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1173666"],"award-info":[{"award-number":["1173666"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>The cost in managing hospitalised dengue patients varies across countries depending on access to healthcare, management guidelines, and state sponsored subsidies. For health budget planning, locally relevant, accurate costing data from prospective studies, is essential.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To characterise the direct costs of managing hospitalised patients with suspected dengue infection in Sri Lanka.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Colombo Dengue Study is a prospective single centre cohort study in Sri Lanka recruiting suspected hospitalised dengue fever patients in the first three days of fever and following them up until discharge. The diagnosis of dengue is retrospectively confirmed and the cohort therefore has a group of non-dengue fever patients with a phenotypically similar illness, managed as dengue while in hospital. The direct costs of hospital admission (base and investigation costs, excluding medication) were calculated for all recruited patients and compared between dengue and non-dengue categories as well as across subgroups (demographic, clinical or temporal) within each of these categories. We also explored if excluding dengue upfront, would lead to an overall cost saving in several hypothetical scenarios.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>From October 2017 to February 2020, 431 adult dengue patients and 256 non-dengue fever patients were recruited. The hospitalisation costs were USD 18.02 (SD: 4.42) and USD 17.55 (SD: 4.09) per patient per day for dengue and non-dengue patients respectively (p&gt;0.05). Laboratory investigations (haematological, biochemical and imaging) accounted for more than 50% of the total cost. The costs were largely homogenous in all subgroups within or across dengue and non-dengue categories. Excluding dengue upfront by subsidised viral genomic testing may yield overall cost savings for non-dengue patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>As non-dengue patients incur a similar cost per day as the dengue patients, confirming dengue diagnosis using subsidised tests for patients presenting in the first three days of fever may be cost-efficient.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0258388","type":"journal-article","created":{"date-parts":[[2021,10,9]],"date-time":"2021-10-09T23:10:14Z","timestamp":1633821014000},"page":"e0258388","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Direct costs of managing in-ward dengue patients in Sri Lanka: A prospective study"],"prefix":"10.1371","volume":"16","author":[{"given":"Chathurani","family":"Sigera","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2189-9177","authenticated-orcid":true,"given":"Chaturaka","family":"Rodrigo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4467-3659","authenticated-orcid":true,"given":"Nipun L.","family":"de Silva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Praveen","family":"Weeratunga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2535-9031","authenticated-orcid":true,"given":"Deepika","family":"Fernando","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1965-6678","authenticated-orcid":true,"given":"Senaka","family":"Rajapakse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,10,8]]},"reference":[{"issue":"7446","key":"pone.0258388.ref001","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1038\/nature12060","article-title":"The global distribution and burden of dengue","volume":"496","author":"S Bhatt","year":"2013","journal-title":"Nature"},{"key":"pone.0258388.ref002","unstructured":"World Health Organization. Dengue and Severe Dengue 2018 [2018 November 1]. Available from: http:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/dengue-and-severe-dengue."},{"key":"pone.0258388.ref003","unstructured":"World Health Organization. Vector Surveillance: WHO; 2018 [2018 December 1]. Available from: https:\/\/www.who.int\/denguecontrol\/monitoring\/vector_surveillance\/en\/."},{"issue":"2","key":"pone.0258388.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004466","article-title":"Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka","volume":"10","author":"N Thalagala","year":"2016","journal-title":"PLoS neglected tropical diseases"},{"key":"pone.0258388.ref005","doi-asserted-by":"crossref","first-page":"103","DOI":"10.2147\/IDR.S22613","article-title":"Treatment of dengue fever","volume":"5","author":"S Rajapakse","year":"2012","journal-title":"Infection and drug resistance"},{"issue":"10","key":"pone.0258388.ref006","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/trstmh\/trx079","article-title":"Prophylactic and therapeutic interventions for bleeding in dengue: a systematic review","volume":"111","author":"S Rajapakse","year":"2017","journal-title":"Transactions of the Royal Society of Tropical Medicine and Hygiene"},{"issue":"4","key":"pone.0258388.ref007","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s00408-017-0021-6","article-title":"Dengue Hemorrhagic Fever: A State-of-the-Art Review Focused in Pulmonary Involvement","volume":"195","author":"RR de Almeida","year":"2017","journal-title":"Lung"},{"issue":"8","key":"pone.0258388.ref008","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1111\/j.1365-3156.2011.02793.x","article-title":"Multicentre prospective study on dengue classification in four South-east Asian and three Latin American countries","volume":"16","author":"N Alexander","year":"2011","journal-title":"Trop Med Int Health"},{"issue":"1","key":"pone.0258388.ref009","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1186\/s12879-019-4304-9","article-title":"Risk prediction for severe disease and better diagnostic accuracy in early dengue infection; the Colombo dengue study","volume":"19","author":"PC Sigera","year":"2019","journal-title":"BMC infectious diseases"},{"key":"pone.0258388.ref010","article-title":"Prediction of plasma leakage phase of dengue in resource limited settings","author":"HMMTB Herath","journal-title":"Clinical Epidemiology and Global Health"},{"key":"pone.0258388.ref011","unstructured":"World Health Organization. Dengue guidelines for diagnosis, treatment, prevention and control. New Delhi: WHO; 2009."},{"key":"pone.0258388.ref012","unstructured":"World Health Organization. Dengue haemorrhagic fever: diagnosis, treatment and control. Geneva: WHO; 1997."},{"key":"pone.0258388.ref013","unstructured":"Ministry of Health Sri Lanka. Guidelines on management of dengue fever and dengue haemorrhagic fever in adults. Colombo, Sri Lanka: Ministry of Health Sri Lanka; 2012."},{"issue":"5","key":"pone.0258388.ref014","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1017\/S1049023X11006637","article-title":"Sonographic evidence of ascites, pleura-pericardial effusion and gallbladder wall edema for dengue fever","volume":"26","author":"M Motla","year":"2011","journal-title":"Prehospital and disaster medicine"},{"issue":"4","key":"pone.0258388.ref015","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1097\/01.inf.0000258612.26743.10","article-title":"Natural history of plasma leakage in dengue hemorrhagic fever: a serial ultrasonographic study","volume":"26","author":"A Srikiatkhachorn","year":"2007","journal-title":"The Pediatric infectious disease journal"},{"issue":"2","key":"pone.0258388.ref016","first-page":"84","article-title":"Gallbladder edema in Dengue hemorrhagic fever and its association with haematocrit levels and type of infections","volume":"36","author":"I Zulkarnain","year":"2004","journal-title":"Acta medica Indonesiana"},{"issue":"6","key":"pone.0258388.ref017","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1016\/j.jmii.2016.08.024","article-title":"Analyses of clinical and laboratory characteristics of dengue adults at their hospital presentations based on the World Health Organization clinical-phase framework: Emphasizing risk of severe dengue in the elderly","volume":"51","author":"HJ Kuo","year":"2018","journal-title":"Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi"},{"issue":"7","key":"pone.0258388.ref018","doi-asserted-by":"crossref","first-page":"e2972","DOI":"10.1371\/journal.pntd.0002972","article-title":"Predictive Tools for Severe Dengue Conforming to World Health Organization 2009 Criteria","volume":"8","author":"LR Carrasco","year":"2014","journal-title":"PLoS Neglected Tropical Diseases"},{"key":"pone.0258388.ref019","unstructured":"Ministry of Health. Goverment circular on charges for non-citizen inpatients in public sector hospitals (no. 1\/41\/2017). Colombo, Sri Lanka: Ministry of Health; 2017."},{"key":"pone.0258388.ref020","unstructured":"World Bank. Sri Lanka Open Datasets Washington D.C.: World Bank; 2020 [2021 Feb 11]. Available from: https:\/\/data.worldbank.org\/country\/sri-Lanka."},{"issue":"4","key":"pone.0258388.ref021","doi-asserted-by":"crossref","first-page":"682","DOI":"10.3201\/eid2604.190435","article-title":"Severe Dengue Epidemic, Sri Lanka, 2017","volume":"26","author":"HA Tissera","year":"2020","journal-title":"Emerging infectious diseases"},{"key":"pone.0258388.ref022","article-title":"Dengue and post-infection fatigue: findings from a prospective cohort-the Colombo Dengue Study","author":"PC Sigera","year":"2020","journal-title":"Transactions of the Royal Society of Tropical Medicine and Hygiene"},{"key":"pone.0258388.ref023","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1186\/s12879-016-1656-2","article-title":"Patterns and causes of liver involvement in acute dengue infection","volume":"16","author":"S Fernando","year":"2016","journal-title":"BMC infectious diseases"},{"key":"pone.0258388.ref024","unstructured":"Medical Research Institute of Sri Lanka. Investigation Costs Colombo, Sri Lanka: Ministry of Health, Sri Lanka; 2020 [12 February 2021]. Available from: www.mri.gov.lk\/wp-content\/uploads\/2020\/02\/MRI-investigations-03.02.2020.pdf."},{"key":"pone.0258388.ref025","unstructured":"UNICEF. Sri Lanka budget brief: Health Sector. Colombo, Sri Lanka: UNICEF, 2020."},{"key":"pone.0258388.ref026","unstructured":"Epidemiology Unit Sri Lanka. Disease Surveillance: Trends\u2014Dengue Colombo Sri Lanka: Ministry of Health, Sri Lanka; 2021 [11 Feb 2021]. Available from: http:\/\/www.epid.gov.lk\/web\/index.php?option=com_casesanddeaths&Itemid=448&lang=en."},{"issue":"2","key":"pone.0258388.ref027","doi-asserted-by":"crossref","first-page":"e0211401","DOI":"10.1371\/journal.pone.0211401","article-title":"Cost of illness and program of dengue: A systematic review","volume":"14","author":"LNdS Oliveira","year":"2019","journal-title":"PLoS One"},{"issue":"4","key":"pone.0258388.ref028","doi-asserted-by":"crossref","first-page":"205","DOI":"10.4038\/sljch.v43i4.7762","article-title":"Economic cost of hospitalized non-fatal paediatric dengue at the Lady Ridgeway Hospital for Children in Sri Lanka","volume":"43","author":"M Senanayake","year":"2014","journal-title":"Sri Lanka Journal of Child Health"},{"issue":"9","key":"pone.0258388.ref029","doi-asserted-by":"crossref","first-page":"e3104","DOI":"10.1371\/journal.pntd.0003104","article-title":"Direct Costs of Dengue Hospitalization in Brazil: Public and Private Health Care Systems and Use of WHO Guidelines","volume":"8","author":"AA Vieira Machado","year":"2014","journal-title":"PLOS Neglected Tropical Diseases"},{"issue":"8","key":"pone.0258388.ref030","doi-asserted-by":"crossref","first-page":"e0005784","DOI":"10.1371\/journal.pntd.0005784","article-title":"Direct cost of dengue hospitalization in Zhongshan, China: Associations with demographics, virus types and hospital accreditation","volume":"11","author":"JH Zhang","year":"2017","journal-title":"PLoS neglected tropical diseases"},{"issue":"9","key":"pone.0258388.ref031","doi-asserted-by":"crossref","first-page":"e0005961","DOI":"10.1371\/journal.pntd.0005961","article-title":"Household costs of hospitalized dengue illness in semi-rural Thailand","volume":"11","author":"Y Tozan","year":"2017","journal-title":"PLOS Neglected Tropical Diseases"},{"issue":"10","key":"pone.0258388.ref032","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/j.pt.2018.07.007","article-title":"The Estimates of the Health and Economic Burden of Dengue in Vietnam","volume":"34","author":"TM Hung","year":"2018","journal-title":"Trends in parasitology"},{"key":"pone.0258388.ref033","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/CEOR.S124023","article-title":"Economic report on the cost of dengue fever in Vietnam: case of a provincial hospital","volume":"9","author":"LD Pham","year":"2017","journal-title":"ClinicoEconomics and outcomes research: CEOR"},{"key":"pone.0258388.ref034","doi-asserted-by":"crossref","first-page":"S64","DOI":"10.1016\/j.ijid.2019.02.033","article-title":"Direct cost of illness for dengue in hospitalized children and adults at a referral hospital in India","volume":"84","author":"K Panmei","year":"2019","journal-title":"International Journal of Infectious Diseases"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0258388","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,9]],"date-time":"2021-10-09T23:11:19Z","timestamp":1633821079000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0258388"}},"subtitle":[],"editor":[{"given":"Rashidul Alam","family":"Mahumud","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,10,8]]},"references-count":34,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0258388","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,8]]}}}