Global burden of dengue on healthcare systems: a meta-analysis of healthcare resource utilisation

Background Dengue poses an increasing health challenge, yet contemporary global healthcare resource utilisation (HCRU) data remain limited. Methods A systematic literature review (SLR) and meta-analysis of studies published 2013–2026 was conducted to estimate hospitalisation rate (HR) and length of stay (LOS) for dengue. Pooled proportions and means were analysed with 95% confidence intervals (CIs) under fixed- and random-effects models globally and by region. Meta-regression models estimated potential sources of heterogeneity. Additionally, sensitivity (excluding sample sizes <100, >50,000, and >50,000 and <100) and subgroup analyses were conducted for disease severity, patient characteristics, and region (PROSPERO# CRD42023480948). Findings Of 341 studies included in the SLR, studies reporting HR (121) and LOS (204) were prioritised for analysis. Global HR among patients with dengue, irrespective of severity, was 36.7% (95% CI 29.0–44.4), under the random-effects model. HR was higher for severe versus non-severe dengue (79.4% [55.9–92.2] versus 26.6% [19.3–35.4]), with versus without warning signs (36.9% [23.3–52.9] versus 17.7% [10.2–28.9]), and in Asia versus Latin America (35.1% [18.0–57.2] versus 29.3% [18.4–43.2]). Global mean LOS among hospitalised patients with dengue, irrespective of severity, was 4.9 days (95% CI 4.6–5.2) under the random-effects model. Severe dengue had longer LOS versus non-severe dengue (6.5 [5.4–7.7] versus 4.6 [4.3–4.9] days), especially for patients with versus without comorbidities (6.1 [5.1–7.2] versus 5.1 [4.3–5.9] days), and in Asia versus Latin America (5.1 [4.8–5.5] versus 4.1 [3.4–4.7] days). Meta-regression showed disease severity was the single significant factor (p < 0.0001) associated with high HR and longer LOS (I 2 ≥ 99.8%) among the factors analysed. Interpretation Due to high heterogeneity between studies and interregional differences, pooled estimates should be interpreted with caution. These findings indicate the considerable burden of dengue driven by HCRU, offering valuable insights for health system preparedness, clinical trial design, and policy planning. Funding Novartis Pharma AG.