Estimating direct and indirect costs of hospitalised typhoid fever in Indonesia: A multisite healthcare facility and community survey
10 affiliations
- 1Center for Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
- 2Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
- 3Department of Child Health, Faculty of Medicine, Public Health and Nursing, Dr. Sardjito General Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia.
- 4Enteric Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia.
- 5Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
- 6Department of Paediatrics, the University of Melbourne, Parkville, Australia.
- 7STIKes Budi Luhur Cimahi, West Java, Indonesia.
- 8Faculty of Social and Political Sciences, Universitas Sebelas Maret Surakarta, Central Java, Indonesia.
- 9Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
- 10Department of Gastroenterology and Clinical Nutrition, the Royal Children's Hospital, Parkville, Australia.
Abstract
Background: Typhoid fever, caused by the bacterium Salmonella enterica serovar Typhi (S. Typhi), remains a major global threat despite substantial declines over the past three decades. In 2021, an estimated 7.1 million (5.6 to 9.2 million) cases occurred worldwide. Following the WHO’s recommendation, ten countries (excluding Indonesia) have introduced the typhoid conjugate vaccine (TCV). To inform decision-making for the potential introduction of TCV into Indonesia’s National Immunisation Program, we estimated the direct and indirect costs of typhoid fever in Indonesia. Methods: We conducted a multisite, incidence-based cost-of-illness study using a patient-level bottom-up costing approach in 23 hospitals and primary health centres (PHCs) across six provinces. Children (6 months to 17 years) and adults (≥18 years) hospitalised with ICD-10 A01 typhoid fever hospitalised with at least one positive typhoid serodiagnostic result during 2019-2023 (retrospective) and 2022-2023 (prospective), without other major infectious or chronic comorbidities, were identified from facility records. Direct medical costs were obtained retrospectively from hospital/PHC bills and clinical records, while direct non-medical and indirect (productivity loss) costs were collected prospectively through interviewer-administered household questionnaires. Sensitivity analyses re-estimated costs after excluding component-wise outliers and imputing missing income values using the provincial minimum wage. Results: We collected 2,069 records (1,538 retrospective [891 children; 647 adults] and 531 prospective [329 children; 202 adults]) across six provinces. The weighted mean direct medical costs were US$177.0 ± 101.9 for children and US$199.8 ± 119.8 for adults, while the corresponding direct non-medical costs were US$43.7 ± 16.3 and US$39.0 ± 10.9, respectively. Indirect costs were US$23.9. ± 5.6 (children) and US$17.9 ± 5.5 (adults). Private hospitals had the highest total direct medical cost (US$254.4), while PHCs had the lowest (US$47.8). Costs varied substantially by provinces (BPJS tariff regions). Conclusion: Hospitalised typhoid fever imposes a substantial economic burden in Indonesia. These setting- and region-specific cost estimates can inform cost projections and cost-effectiveness analyses for the introduction of the typhoid conjugate vaccine in Indonesia.
Related
- Evaluating Novel Healthcare Approaches to Nurturing and Caring for Hospitalised Elders (ENHANCE): protocol for a stepped wedge, cluster randomised clinical trial for delirium prevention in older adults
- Remote multicomponent intervention for older adults with cognitive impairment in community settings: multisite randomised controlled trial
- Professional practice environment and advanced nursing interventions associated with nurse-perceived quality of healthcare delivery in selected rural facilities in Saudi Arabia: a multisite cross-sectional correlational study
- Nutritional status, clinical burden, and healthcare utilization among pediatric outpatients with congenital heart disease: A retrospective cross-sectional study from Indonesia
- Community-Based Preeclampsia Screening by Midwives and Community Health Workers in Low- and Middle-Income Countries: A Scoping Review and Evidence-Informed Framework for Indonesia
BibTeX
@article{thobari2026estimating,
title = {{Estimating direct and indirect costs of hospitalised typhoid fever in Indonesia: A multisite healthcare facility and community survey}},
author = {Jarir At Thobari and Ida Safitri Laksono and Jonathan Hasian Haposan and Hardini Tri Indarti and Asal Wahyuni Erlin Mulyadi and Alindina Anjani and Emma Watts and Julie Bines},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0360948},
url = {https://doi.org/10.1371/journal.pone.0360948},
note = {CC BY},
}
RIS
TY - JOUR
TI - Estimating direct and indirect costs of hospitalised typhoid fever in Indonesia: A multisite healthcare facility and community survey
AU - Jarir At Thobari
AU - Ida Safitri Laksono
AU - Jonathan Hasian Haposan
AU - Hardini Tri Indarti
AU - Asal Wahyuni Erlin Mulyadi
AU - Alindina Anjani
AU - Emma Watts
AU - Julie Bines
PY - 2026
DA - 2026/10/26
JO - PLOS One
DO - 10.1371/journal.pone.0360948
UR - https://doi.org/10.1371/journal.pone.0360948
AB - Background: Typhoid fever, caused by the bacterium Salmonella enterica serovar Typhi (S. Typhi), remains a major global threat despite substantial declines over the past three decades. In 2021, an estimated 7.1 million (5.6 to 9.2 million) cases occurred worldwide. Following the WHO’s recommendation, ten countries (excluding Indonesia) have introduced the typhoid conjugate vaccine (TCV). To inform decision-making for the potential introduction of TCV into Indonesia’s National Immunisation Program, we estimated the direct and indirect costs of typhoid fever in Indonesia. Methods: We conducted a multisite, incidence-based cost-of-illness study using a patient-level bottom-up costing approach in 23 hospitals and primary health centres (PHCs) across six provinces. Children (6 months to 17 years) and adults (≥18 years) hospitalised with ICD-10 A01 typhoid fever hospitalised with at least one positive typhoid serodiagnostic result during 2019-2023 (retrospective) and 2022-2023 (prospective), without other major infectious or chronic comorbidities, were identified from facility records. Direct medical costs were obtained retrospectively from hospital/PHC bills and clinical records, while direct non-medical and indirect (productivity loss) costs were collected prospectively through interviewer-administered household questionnaires. Sensitivity analyses re-estimated costs after excluding component-wise outliers and imputing missing income values using the provincial minimum wage. Results: We collected 2,069 records (1,538 retrospective [891 children; 647 adults] and 531 prospective [329 children; 202 adults]) across six provinces. The weighted mean direct medical costs were US$177.0 ± 101.9 for children and US$199.8 ± 119.8 for adults, while the corresponding direct non-medical costs were US$43.7 ± 16.3 and US$39.0 ± 10.9, respectively. Indirect costs were US$23.9. ± 5.6 (children) and US$17.9 ± 5.5 (adults). Private hospitals had the highest total direct medical cost (US$254.4), while PHCs had the lowest (US$47.8). Costs varied substantially by provinces (BPJS tariff regions). Conclusion: Hospitalised typhoid fever imposes a substantial economic burden in Indonesia. These setting- and region-specific cost estimates can inform cost projections and cost-effectiveness analyses for the introduction of the typhoid conjugate vaccine in Indonesia.
SN - 1932-6203
ER -