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Review
. 2024 Jun 25;19(6):e0305692.
doi: 10.1371/journal.pone.0305692. eCollection 2024.

The cost of typhoid illness in low- and middle-income countries, a scoping review of the literature

Affiliations
Review

The cost of typhoid illness in low- and middle-income countries, a scoping review of the literature

Frederic Debellut et al. PLoS One. .

Abstract

Typhoid fever is responsible for a substantial health burden in low- and middle-income countries (LMICs). New means of prevention became available with the prequalification of typhoid conjugate vaccines (TCV) by the World Health Organization (WHO) in 2018. Policymakers require evidence to inform decisions about TCV. The economic burden related to typhoid fever can be considerable, both for healthcare providers and households, and should be accounted for in the decision-making process. We aimed to understand the breadth of the evidence on the cost of typhoid fever by undertaking a scoping review of the published literature. We searched scientific databases with terms referring to typhoid fever cost of illness to identify published studies for the period January 1st 2000 to May 24th 2024. We also conferred with stakeholders engaged in typhoid research to identify studies pending completion or publication. We identified 13 published studies reporting empirical data for 11 countries, most of them located in Asia. The total cost of a typhoid episode ranged from $23 in India to $884 in Indonesia (current 2022 United States Dollar [USD]). Household expenditures related to typhoid fever were characterized as catastrophic in 9 studies. We identified 5 studies pending completion or publication, which will provide evidence for 9 countries, most of them located in Africa. Alignment in study characteristics and methods would increase the usefulness of the evidence generated and facilitate cross-country and regional comparison. The gap in evidence across regions should be mitigated when studies undertaken in African countries are published. There remains a lack of evidence on the cost to treat typhoid in the context of increasing antimicrobial resistance. Decision-makers should consider the available evidence on the economic burden of typhoid, particularly as risk factors related to antimicrobial resistance and climate change increase typhoid risk. Additional studies should address typhoid illness costs, using standardized methods and accounting for the costs of antimicrobial resistance.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Existing evidence on cost of typhoid fever per country.
Fig 2
Fig 2. Average total cost of treating a typhoid case in inpatient and outpatient settings.
Values in brackets show 2022 Growth Domestic Product per capita [24]; y.o.: years old.

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References

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Grants and funding

Funding for this work was received by KN from the Bill & Melinda Gates Foundation INV-030857. https://www.gatesfoundation.org/ The funder did not have any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.