Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates

Diarrhea treatment can be expensive for both families and governments. While many studies have reported on the cost of illness for diarrhea (encompassing both direct medical costs and indirect costs, such as travel and lost income), empirical data on the cost of diarrheal illness is sparse, particularly in low- and middle-income countries (LMICs). This study, published in BMC Public Health, first undertook a systematic review of the literature on diarrhea cost of illness in children under 5 years and, secondly, generated modelled estimates of diarrhea cost of illness for children in 137 LMICs. 

The review found that the average cost of illness as published across 25 articles was US$36.56 per outpatient episode and $159.90 per inpatient episode of diarrhea. Direct medical costs accounted for 79% (83% for inpatient and 74% for outpatient) of the total direct costs.

The modelled estimates were generated using data from the articles as well as the World Health Organization’s Choosing Interventions that are Cost-Effective (WHO–CHOICE) database. Across all 137 countries, costs averaged $52.16 per outpatient episode and $216.36 per inpatient episode. 

The authors suggest that, in the absence of country-specific estimates, those generated in this model could serve as useful inputs for planning and prioritizing appropriate health interventions for childhood diarrheal diseases in LMICs.

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