Evaluating the economic burden of dengue in Sri Lanka: A systematic review of costs from 2010 to 2024

Objectives: This systematic literature review aimed to evaluate the direct and indirect costs borne by households and the health care system in managing dengue cases in Sri Lanka. Methods: This review evaluates the economic burden of dengue in Sri Lanka from 2010 to 2024, following the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. The databases PubMed, Embase, Cochrane, and the Database of Abstracts of Reviews of Effects (DARE) were searched, with a final selection of eight studies that covered direct, indirect, and vector control costs. Costs were converted to 2024 US dollar (USD) using the Sri Lankan Consumer Price Index. Results: Direct costs ranged from 19 USD per case in southern Sri Lanka to 242 USD nationally, with hospitalization as a major expense. Indirect costs, including lost income from missed workdays, averaged 371 USD per episode, reducing household income by 6.18%. In 2017, the total annual cost of implementing the dengue vaccination strategy was estimated at USD 28.95 million. In comparison, the total cost of a dengue vector control program was USD 400,496, with a cost of USD 2 per person protected over the intervention period (2014-2016). Psychological effects such as post-infectious fatigue, depression, and anxiety were frequently reported. Conclusions: This review highlights dengue's economic burden in Sri Lanka, emphasizing the need for cost-effective interventions and mental health support, alongside disease management.