S. pyogenes is a major public health concern in many parts of the world. Considering the lack of existing evidence on economic burden for multiple disease manifestations, the current study under the Strep A Vaccine Global Consortium estimates the average economic burden per episode for seven selected disease manifestations caused by S. pyogenes: pharyngitis, acute rheumatic fever (ARF), rheumatic heart disease (RHD), severe RHD, invasive infections, impetigo, and cellulitis.
For this study, we estimated direct medical costs (DMCs), direct non-medical costs (DNMCs), and indirect costs (ICs) of Strep A diseases. Each cost component was separately extrapolated and aggregated to estimate the average economic burden per episode for each disease manifestation by income group. Adjustment factors for DMC and DNMC were generated by comparing the WHO-CHOICE data and GDP per capita with the empirical costs identified in existing studies by income group to overcome related data insufficiencies. To address uncertainty, a probabilistic multivariate sensitivity was carried out, and a Monte Carlo simulation was conducted to estimate 95% confidence intervals.
The estimated average economic burden by income group per episode ranged from US$22 to US$390 for pharyngitis, US$231 to US$6,390 for ARF, US$448 to US$11,765 for RHD, US$954 to US$39,720 for severe RHD, US$660 to US$34,070 for invasive infections, US$25 to US$2,904 for impetigo, and US$47 to US$2,728 for cellulitis across income groups.
Overall, existing studies that reported cost of illness for Strep A-induced disease manifestations were scarce. The significant amount of economic burden for multiple Strep A disease manifestations underscores the urgent need to develop effective prevention strategies including vaccines.