Abstract
ObjectivesTo estimate the annual cost to patients, the health service and society of infectious intestinal disease (IID) from Campylobacter, norovirus and rotavirus.DesignSecondary data analysis.SettingThe United Kingdom population, 2008–9.Main outcome measuresCases and frequency of health services usage due to these three pathogens; associated healthcare costs; direct, out-of-pocket expenses; indirect costs to patients and caregivers.ResultsThe median estimated costs to patients and the health service at 2008–9 prices were: Campylobacter £50 million (95% CI: £33m–£75m), norovirus £81 million (95% CI: £63m–£106m), rotavirus £25m (95% CI: £18m–£35m). The costs per case were approximately £30 for norovirus and rotavirus, and £85 for Campylobacter. This was mostly borne by patients and caregivers through lost income or out-of-pocket expenditure. The cost of Campylobacter-related Guillain-Barré syndrome hospitalisation was £1.26 million (95% CI: £0.4m–£4.2m).ConclusionsNorovirus causes greater economic burden than Campylobacter and rotavirus combined. Efforts to control IID must prioritise norovirus. For Campylobacter, estimated costs should be considered in the context of expenditure to control this pathogen in agriculture, food production and retail. Our estimates, prior to routine rotavirus immunisation in the UK, provide a baseline vaccine cost-effectiveness analyses.
Highlights
Infectious intestinal disease (IID) causes substantial disease burden in both high- and lowincome countries
In a population-based study conducted in 2008–9 (IID2), it was estimated that a quarter of the UK population experiences IID annually [1]; norovirus and Campylobacter, the most common viral and bacterial pathogens, account for 3 million and 0.5 million annual cases respectively
In a study of the health and economic burden of IID (IID1), conducted in the 1990s, the societal cost, including both costs to the health service and to patients, was estimated to be nearly £750 million annually (1994–5 prices), with the greatest shares coming from Campylobacter (£69.6 million), E. coli (£69.3 million, including non-Shiga toxin-producing strains), Salmonella (£46.4 million), norovirus (£24.4 million) and rotavirus (£18.2 million) [2]
Summary
Infectious intestinal disease (IID) causes substantial disease burden in both high- and lowincome countries. In a study of the health and economic burden of IID (IID1), conducted in the 1990s, the societal cost, including both costs to the health service and to patients, was estimated to be nearly £750 million annually (1994–5 prices), with the greatest shares coming from Campylobacter (£69.6 million), E. coli (£69.3 million, including non-Shiga toxin-producing strains), Salmonella (£46.4 million), norovirus (£24.4 million) and rotavirus (£18.2 million) [2]. These costs are a gross underestimate for norovirus, as current molecular diagnostics are far superior to electron microscopy used in IID1 [3][4]. Campylobacter and norovirus are both high priority pathogens in the UK Food Standards Agency’s foodborne disease strategy [7], while the recent introduction of routine rotavirus immunisation, and increasing prospects for introduction of norovirus vaccines make these two pathogens very relevant to control policy
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