Economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh during 2010

Mejbah U Bhuiyan, Stephen P Luby, Nadia I Alamgir, Nusrat Homaira, Abdullah A Mamun, Jahangir A M Khan, Jaynal Abedin, Katharine Sturm-Ramirez, Emily S Gurley, Rashid U Zaman, A S M Alamgir, Mahmudur Rahman, Marc-Alain Widdowson, Eduardo Azziz-Baumgartner, Mejbah U Bhuiyan, Stephen P Luby, Nadia I Alamgir, Nusrat Homaira, Abdullah A Mamun, Jahangir A M Khan, Jaynal Abedin, Katharine Sturm-Ramirez, Emily S Gurley, Rashid U Zaman, A S M Alamgir, Mahmudur Rahman, Marc-Alain Widdowson, Eduardo Azziz-Baumgartner

Abstract

Objective: Understanding the costs of influenza-associated illness in Bangladesh may help health authorities assess the cost-effectiveness of influenza prevention programs. We estimated the annual economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh.

Design: From May through October 2010, investigators identified both outpatients and inpatients at four tertiary hospitals with laboratory-confirmed influenza infection through rRT-PCR. Research assistants visited case-patients' homes within 30 days of hospital visit/discharge and administered a structured questionnaire to capture direct medical costs (physician consultation, hospital bed, medicines and diagnostic tests), direct non-medical costs (food, lodging and travel) and indirect costs (case-patients' and caregivers' lost income). We used WHO-Choice estimates for routine healthcare service costs. We added direct, indirect and healthcare service costs to calculate cost-per-episode. We used median cost-per-episode, published influenza-associated outpatient and hospitalization rates and Bangladesh census data to estimate the annual economic burden of influenza-associated illnesses in 2010.

Results: We interviewed 132 outpatients and 41 hospitalized patients. The median cost of an influenza-associated outpatient visit was US$4.80 (IQR = 2.93-8.11) and an influenza-associated hospitalization was US$82.20 (IQR = 59.96-121.56). We estimated that influenza-associated outpatient visits resulted in US$108 million (95% CI: 76-147) in direct costs and US$59 million (95% CI: 37-91) in indirect costs; influenza-associated hospitalizations resulted in US$1.4 million (95% CI: 0.4-2.6) in direct costs and US$0.4 million (95% CI: 0.1-0.8) in indirect costs in 2010.

Conclusions: In Bangladesh, influenza-associated illnesses caused an estimated US$169 million in economic loss in 2010, largely driven by frequent but low-cost outpatient visits.

Keywords: Bangladesh; cost; hospitalization; influenza; outpatient.

© 2014 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Sentinel influenza surveillance catchment sites in Bangladesh, 2010.

References

    1. Nicholson KG, Wood JM, Zambon M. Influenza. Lancet. 2003;362:1733–1745.
    1. Simonsen L. The global impact of influenza on morbidity and mortality. Vaccine. 1999;17(Suppl 1):S3–S10.
    1. World Health Organization. 2009. Influenza (Seasonal). Available at (Accessed 17 October 2011)
    1. Azziz-Baumgartner E, Alamgir AS, Rahman M, et al. Incidence of influenza-like illness and severe acute respiratory infection during three influenza seasons in Bangladesh, 2008–2010. Bull World Health Organ. 2011;90:12–19.
    1. Homaira N, Luby SP, Islam K, et al. Incidence of influenza-associated hospitalization in children aged <5 years in Bangladesh, 2010–2011. Incidence, Severity, and Impact 2012 5-8 September 2012; Munich, Germany 2012.
    1. Zaman RU, Alamgir AS, Rahman M, et al. Influenza in outpatient ILI case-patients in national hospital-based surveillance, Bangladesh, 2007–2008. PLoS ONE. 2009;4:e8452.
    1. Molinari NA, Ortega-Sanchez IR, Messonnier ML, et al. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine. 2007;25:5086–5096.
    1. Keech M, Beardsworth P. The impact of influenza on working days lost: a review of the literature. Pharmacoeconomics. 2008;26:911–924.
    1. Li S, Leader S. Economic burden and absenteeism from influenza-like illness in healthy households with children (5–17 years) in the US. Respir Med. 2007;101:1244–1250.
    1. Anonymous. Economic and social impact of epidemic and pandemic influenza. Vaccine. 2006;24:6776–6778.
    1. Simmerman JM, Lertiendumrong J, Dowell SF, et al. The cost of influenza in Thailand. Vaccine. 2006;24:4417–4426.
    1. Alamgir NI, Naheed A, Luby SP. Coping strategies for financial burdens in families with childhood pneumonia in Bangladesh. BMC Public Health. 2010;10:622.
    1. International Centre for Diarrheal Disease Research Bangladesh. The economic burden of influenza-like illness in Mirpur, Dhaka, during the 2009 pandemic: a household cost of illness study. Health Sci Bull. 2010;8:12–18.
    1. van Doorslaer E. 2005. Paying out-of-pocket for health care in Asia: Catastrophic and poverty impact EQUITAP Project: Working paper#2. Available at (Accessed 7 November 2011)
    1. van Doorslaer E, O'Donnell O, Rannan-Eliya RP, et al. Effect of payments for health care on poverty estimates in 11 Countries in Asia: an analysis of household survey data. Lancet. 2006;368:1357–1364.
    1. World Health Organization. Health System in Bangladesh. Available at (Accessed 19 December 2011)
    1. World Bank. Countries and Economic 2012. Available at (Accessed 12 August 2012)
    1. Centers for Disease Control and Prevention. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Recomm Rep. 2002;51:1–31.
    1. Jefferson T, Foxlee R, Del Mar C, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ. 2008;336:77–80.
    1. Talaat M, Afifi S, Dueger E, et al. Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt. Emerg Infect Dis. 2011;17:619–625.
    1. Fiore AE, Shay DK, Broder K, et al. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. MMWR Recomm Rep. 2008;57:1–60.
    1. Nichol KL. The efficacy, effectiveness and cost-effectiveness of inactivated influenza virus vaccines. Vaccine. 2003;21:1769–1775.
    1. White T, Lavoie S, Nettleman MD. Potential cost savings attributable to influenza vaccination of school-aged children. Pediatrics. 1999;103:e73.
    1. Segel JE. 2006. Cost-of-illness studies-a primer: RTI International. Available at (Accessed 15 December 2011)
    1. World Health Organization. 2013. CHOosing Interventions that are Cost Effective (WHO-CHOICE): Country-specific unit costs. Available at (Accessed 8 April 2013)
    1. Koopmanschap MA, Rutten FF. A practical guide for calculating indirect costs of disease. Pharmacoeconomics. 1996;10:460–466.
    1. Stewart MK, Parker B, Chakraborty J, Begum H. Acute respiratory infections (ARI) in rural Bangladesh: perceptions and practices. Med Anthropol. 1994;15:377–394.
    1. Blum LS, Khan R, Nahar N, Breiman RF. In-depth assessment of an outbreak of Nipah encephalitis with person-to-person transmission in Bangladesh: implications for prevention and control strategies. Am J Trop Med Hyg. 2009;80:96–102.
    1. Government of the People's Republic of Bangladesh. 2010. Activities of ministry of labour and employment for two years (2009–2010). Available at (Accessed 21 January 2011)
    1. Bangladesh Bank. Exchange rate of taka. Available at (Accessed 28 January 2011)
    1. Bangladesh Bureau of Statistics. Population Census–2001, Community Series. Dhaka, Bangladesh: Bangladesh Bureau of Statistics; 2001.
    1. Xue Y, Kristiansen IS, de Blasio BF. Modeling the cost of influenza: the impact of missing costs of unreported complications and sick leave. BMC Public Health. 2010;10:724.
    1. Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21:459–468.
    1. Fairbrother G, Cassedy A, Ortega-Sanchez IR, et al. High costs of influenza: direct medical costs of influenza disease in young children. Vaccine. 2010;28:4913–4919.
    1. Gavin PJ, Thomsom RB., Jr Review of rapid diagnostic tests for influenza. Clin Appl Immunol Rev. 2003;4:151–172.
    1. Duggal R. Poverty & health: criticality of public financing. Indian J Med Res. 2007;126:309–317.
    1. van Doorslaer E, O'Donnell O, Rannan-Eliya RP, et al. Catastrophic payments for health care in Asia. Health Econ. 2007;16:1159–1184.
    1. Ahmed T, Ahmed AMS. Reducing the burden of malnutrition in Bangladesh. BMJ. 2009;339:b4490.
    1. McIntyre D, Thiede M, Dahlgren G, Whitehead M. What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts? Soc Sci Med. 2006;62:858–865.
    1. World Bank. Bangladesh. Available at (Accessed 15 July 2011)
    1. Warren-Gash C, Smeeth L, Hayward AC. Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic review. Lancet Infect Dis. 2009;9:601–610.
    1. Brooks WA, Goswami D, Rahman M, et al. Influenza is a major contributor to childhood pneumonia in a tropical developing country. Pediatr Infect Dis J. 2009;29:216–221.
    1. Broor S, Parveen S, Bharaj P, et al. A prospective three-year cohort study of the epidemiology and virology of acute respiratory infections of children in rural India. PLoS ONE. 2007;2:e491.
    1. Ng TP, Pwee KH, Niti M, Goh LG. Influenza in Singapore: assessing the burden of illness in the community. Ann Acad Med Singapore. 2002;31:182–188.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever