Economic Burden of Typhoid among Hospitalized Children in Kenya

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Abstract Typhoid remains endemic in many low and middle-income countries, with the highest incidence reported in children under 15 years. No published study has estimated the cost of hospitalized paediatric typhoid cases in Kenya. This analysis estimated the direct medical, direct non-medical, and indirect costs from the healthcare provider and societal perspectives and assessed the proportion of households that would experience catastrophic health expenditure (CHE) due to the disease. Patient-level data on hospitalized children with typhoid were drawn from 16 public hospitals that are part of the Clinical Information Network (CIN) in Kenya. A cost-of-illness analysis was conducted. Resource quantities were extracted from CIN data, and unit costs were obtained from price lists, surveys and expert interviews. All costs were converted to 2025 KES and USD. A simulation-based catastrophic health expenditure analysis was conducted. One-way sensitivity analysis varied hospital bed, staff, non-medical and indirect costs. Median cost per unique admission was USD 79.68 from the provider and USD 96.95 from the societal perspective. Staff costs accounted for up to 55% of societal costs, while hospital-bed costs accounted for up to 15%. Productivity loss represented 12% of societal costs. In the sensitivity analysis, adjusting staff time increased the median cost by 89% for the provider perspective and 74% for the societal perspective. Conversely, varying median daily bed charges between the 25th and 75th percentiles altered the cost of treatment by -9% to 5% for the provider and -5% to 5% for the societal perspectives. CHE incidence rose as the share paid out-of-pocket increased and house wealth declined, mainly impacting rural and poorer households. Typhoid imposes a substantial economic burden among hospitalized children in Kenya, driven mainly by staff and hospital-bed costs. The findings of this study can guide policymakers in reducing strain on health services and the financial burden on families. What is already known on this topic Typhoid is endemic in Kenya, and although its epidemiology is well described, the economic burden has not been quantified. The gap limits the evidence available to guide financing decisions and investments in prevention strategies. What this study adds This study provides the first estimate of the economic burden of hospitalised paediatric typhoid in Kenya, identifies key cost drivers, and notable cost differences across geographic settings and patient groups. It also highlights the financial strain that typhoid can place on affected households. How this study might affect research, practice or policy The study provides researchers with a methodology for assessing catastrophic health expenditure when household level data is not available. The outputs of the study can be used to evaluate the value of vaccines for typhoid in similar contexts. These findings offer policymakers, local evidence to guide decisions for insurance and health financing, especially in settings and patient groups where the financial burden is greatest.

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