Cost for physician-diagnosed influenza and influenza-like illnesses on primary care level in Germany--results of a database analysis from May 2010 to April 2012.

Birgit Ehlken,Johannes Hain,Klaus Wahle,Anastassia Anastassopoulou,Claudia Schröder

doi:10.1186/s12889-015-1885-0

Abstract

BackgroundSeasonal influenza is one of the most significant infectious diseases in Germany; epidemic outbreaks occur every winter and cause substantial morbidity and mortality. However, published data from Germany on the current economic burden of influenza and the costs per episode are lacking.MethodsA retrospective database analysis was conducted using a longitudinal electronic medical records database (IMS Disease Analyzer). Patients with influenza, diagnosed by German office-based physicians using ICD-10 J09-11 (International Classification of Diseases, 10th revision), who were observable in the database from 12 months before the index (diagnosis) date until 1 month afterwards, were included. The selection window, defined to cover two influenza seasons, was May 2010 to April 2012. Direct and indirect costs were evaluated from payer, patient and societal perspectives. Published unit costs and tariffs from Germany (2012) were used for the analysis.ResultsA total of 21,039 influenza-attributable episodes in 17,836 adults, managed by primary care physicians (PCP) and 7,107 episodes in 6,288 children, managed by pediatricians, were eligible for analysis. The mean (±Standard Deviation (SD)) age of the adults with at least one episode was 46 (±18) years and 7 (±4) years in the children. The presence of clinical risk factors was documented for 39 % episodes in adults and 24 % episodes in children, with the most common being cardiovascular diseases in adults (29 %) and chronic respiratory diseases in children (23 %). Complications and severe symptoms accompanied the influenza-attributable episode (adults: 37 %, children: 54 %), bronchitis (adults: 16 %, children: 19 %) and acute upper respiratory infection (adults: 15 %, children: 21 %) being the most frequent. From a societal perspective, the total average mean cost (±SD) per episode was €514 (±609) in adults, where work days lost were the main cost driver (82 %), and €105 (±224) in children. Complications and severe symptoms increased the cost per episode versus episodes without by 1.7 times in adults (€684 (±713) vs. €413 (±510)) and nearly 3 times in children (€149 (±278) vs. €55 (±116)).ConclusionsBased on a large patient sample derived from representative PCP and pediatricians panels, our results demonstrate that seasonal influenza is associated with substantial clinical and economic burden in Germany.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1885-0) contains supplementary material, which is available to authorized users.

Highlights

Seasonal influenza is one of the most significant infectious diseases in Germany; epidemic outbreaks occur every winter and cause substantial morbidity and mortality
The current retrospective database analysis aims to fill the research gap, which has existed in Germany for over 10 years, by describing and quantifying the economic burden associated with seasonal influenza in children and adults at the primary care level. Study design This was a retrospective cost-of-illness analysis, using data from a longitudinal electronic medical records (EMR) database (IMS Disease Analyzer (DA)) in Germany to estimate the cost per influenza or influenza-like illness (ILI) episode
Between May 2010 and April 2012, 42,822 episodes in 37,471 patients ≥17 years were identified in the primary care physicians (PCP) panel and 12,295 episodes in 11,049 patients

Summary

Introduction

Seasonal influenza is one of the most significant infectious diseases in Germany; epidemic outbreaks occur every winter and cause substantial morbidity and mortality. Published data from Germany on the current economic burden of influenza and the costs per episode are lacking. Despite putting a high burden on patients and being of high socio-economic relevance to society, influenza is often regarded as an unproblematic and self-limiting disease, though, epidemic outbreaks, affecting all age groups, occur every winter and cause substantial morbidity and mortality. In Germany, the sole cost of the 1996 influenza epidemic was estimated at €2.6 billion (DM 5 billion) including direct costs, due to hospitalization, outpatient care and medication, as well as indirect costs, due to loss of work force productivity and absenteeism from work [3]. Indirect costs arising during an influenza season were found to make up 80–90 % of the total costs in Germany and France [3, 5]

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Conclusion