Direct and Indirect Costs of Acute Diarrhea in Children Under-Five Years Old in Indonesia

Background: Diarrhea remains a major cause of morbidity and mortality amongst children under five years of age in low- and middle-income countries. This study aimed to estimate the direct and indirect costs of acute diarrhea in children under five years old treated in both outpatient and inpatient care settings in Indonesia. Methods: Direct medical cost data were extracted retrospectively for 1050 children under five years old with acute diarrhea receiving inpatient care across 45 health facilities in seven Indonesian provinces during 2017-2020. Direct medical costs for children treated in outpatient settings were estimated by collecting unit costs associated with standard diarrhea case management in children. A structured interview of 240 inpatients’ caregivers was also conducted retrospectively to estimate direct non-medical costs as well as indirect costs from caregiver income loss. We did not estimate non-medical or indirect costs for outpatient clinic visits. Results: The weighted average direct medical cost per case of inpatient and outpatient diarrhea across all health facility types was US$99·8±56·8 (35% room costs, 29% professional fees, 26% medication costs, 10% diagnostic costs) and US$7·6±4·3 (34% diagnostic costs, 28% medication costs, 27% professional fees, 10% registration fees), respectively. The average direct non-medical household costs and indirect costs for a diarrheal admission were US$4·90 and US$9·90, respectively. Conclusion: This study highlighted essential details on the direct and indirect economic burden acute diarrhea represents for Indonesia in both inpatient and outpatient settings. Funding: This work was supported by the Murdoch Children’s Research Institute (MCRI), PATH, and the Indonesian Technical Advisory Group on Immunization (ITAGI). Declaration of Interest: None to declare. Ethical Approval: The study was approved by the Medical and Research Ethics Committee of the Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, Indonesia (No. KE/FK/0348/EC/2019) and the Royal Children’s Hospital Melbourne Human Research Ethics Committee, Australia.