Direct Medical Costs of 3 Reportable Travel-Related Infections in Ontario, Canada, 2012-2014.

Rachel D Savage,Laura C Rosella,Laura Holder,Kamran Khan,Natasha S Crowcroft,Monali Varia,Maureen Horn

doi:10.3201/eid2508.190222

Abstract

Immigrants traveling to their birth countries to visit friends or relatives are disproportionately affected by travel-related infections, in part because most preventive travel health services are not publicly funded. To help identify cost-effective policies to reduce this disparity, we measured the medical costs (in 2015 Canadian dollars) of 3 reportable travel-related infectious diseases (hepatitis A, malaria, and enteric fever) that accrued during a 3-year period (2012–2014) in an ethnoculturally diverse region of Canada (Peel, Ontario) by linking reportable disease surveillance and health administrative data. In total, 318 case-patients were included, each matched with 2 controls. Most spending accrued in inpatient settings. Direct healthcare spending totaled $2,058,196; the mean attributable cost per case was $6,098 (95% CI $5,328–$6,868) but varied by disease (range $4,558–$7,852). Costs were greatest for enteric fever. Policies that address financial barriers to preventive health services for high-risk groups should be evaluated.

Highlights

Immigrants traveling to their birth countries to visit friends or relatives are disproportionately affected by travel-related infections, in part because most preventive travel health services are not publicly funded
We identified the laboratory-confirmed hepatitis A, malaria, and enteric fever case-patients reported to Peel Public Health during January 1, 2012–December 31, 2014, using the integrated Public Health Information System
During 2012–2014, a total of 289 cases of hepatitis A, malaria, or enteric fever were reported to Peel Public Health in case-patients linkable to the health administrative data, a linkage ratio of 90% (289/321)

Summary

Introduction

Immigrants traveling to their birth countries to visit friends or relatives are disproportionately affected by travel-related infections, in part because most preventive travel health services are not publicly funded. To help identify cost-effective policies to reduce this disparity, we measured the medical costs (in 2015 Canadian dollars) of 3 reportable travel-related infectious diseases (hepatitis A, malaria, and enteric fever) that accrued during a 3-year period (2012–2014) in an ethnoculturally diverse region of Canada (Peel, Ontario) by linking reportable disease surveillance and health administrative data. The Committee to Advise on Tropical Medicine and Travel recommends that nonimmune travelers going to developing countries receive the hepatitis A vaccine [15], travelers going to South Asia receive the typhoid vaccine [16], and travelers going to regions where malaria is endemic receive chemoprophylaxis [17] before traveling Despite these recommendations, pretravel health services are generally not covered by provincial universal insurance plans, with few exceptions [18]. RESEARCH infections in an ethnoculturally diverse region of Canada by linking public health reportable disease surveillance data with health administrative data

Methods

Results

Conclusion