Epidemiology and Infection

Gastrointestinal infections

Costs of illness due to endemic cholera

C. POULOSa1 c1, A. RIEWPAIBOONa2, J. F. STEWARTa3, J. CLEMENSa4, S. GUHa3, M. AGTINIa5, D. SURa6, Z. ISLAMa7, M. LUCASa8, D. WHITTINGTONa3a9 and the DOMI Cholera COI Study Group

a1 Research Triangle Institute, Durham, NC, USA

a2 Mahidol University, Thailand

a3 University of North Carolina at Chapel Hill, USA

a4 International Vaccine Institute, South Korea

a5 National Institute of Health Research & Development, Indonesia

a6 National Institute of Cholera and Enteric Diseases, India

a7 International Center for Diarrhoeal Disease Research, Bangladesh

a8 Ministry of Science and Technology, Mozambique (formerly of the Centre for Environmental Hygiene and Medical Examination)

a9 Manchester University, Manchester, UK

a10 University of Indonesia, Jakarta, Indonesia

a11 Centre for Environmental Hygiene and Medical Examination, Mozambique

a12 University of Washington, USA

a13 North Carolina Central University, USA


Economic analyses of cholera immunization programmes require estimates of the costs of cholera. The Diseases of the Most Impoverished programme measured the public, provider, and patient costs of culture-confirmed cholera in four study sites with endemic cholera using a combination of hospital- and community-based studies. Families with culture-proven cases were surveyed at home 7 and 14 days after confirmation of illness. Public costs were measured at local health facilities using a micro-costing methodology. Hospital-based studies found that the costs of severe cholera were US$32 and US$47 in Matlab and Beira. Community-based studies in North Jakarta and Kolkata found that cholera cases cost between US$28 and US$206, depending on hospitalization. Patients' cost of illness as a percentage of average monthly income were 21% and 65% for hospitalized cases in Kolkata and North Jakarta, respectively. This burden on families is not captured by studies that adopt a provider perspective.

(Accepted March 06 2011)

(Online publication April 18 2011)


c1 Author for correspondence: Dr C. Poulos, Research Triangle Institute, 200 Park Offices, Durham, NC 27709, USA. (Email: cpoulos@rti.org)


† The DOMI Cholera COI Study Group is listed in the Appendix.