Abstract
BackgroundHand, foot and mouth disease (HFMD) is a common illness in China that mainly affects infants and children. The objective of this study is to assess the economic cost and health-related quality of life associated with HFMD in China.MethodA telephone survey of caregivers were conducted in 31 provinces across China. Caregivers of laboratory-confirmed HFMD patients who were registered in the national HFMD enhanced surveillance database during 2012–2013 were invited to participate in the survey. Total costs included direct medical costs (outpatient care, inpatient care and self-medication), direct non-medical costs (transportation, nutrition, accommodation and nursery), and indirect costs for lost income associated with caregiving. Health utility weights elicited using EuroQol EQ-5D-3L and EQ-Visual Analogue Scale (VAS) were used to calculate associated loss in quality adjusted life years (QALYs).ResultsThe subjects comprised 1136 mild outpatients, 1124 mild inpatients, 1170 severe cases and 61 fatal cases. The mean total costs for mild outpatients, mild inpatients, severe cases and fatal cases were $201 (95%CI $187, $215), $1072 (95%CI $999, $1144), $3051 (95%CI $2905, $3197) and $2819 (95%CI $2068, $3571) respectively. The mean QALY losses per HFMD episode for mild outpatients, mild inpatients and severe cases were 3.6 (95%CI 3.4, 3,9), 6.9 (95%CI 6.4, 7.4) and 13.7 (95%CI 12.9, 14.5) per 1000 persons. Cases who were diagnosed with EV-A71 infection and had longer duration of illness were associated with higher total cost and QALY loss.ConclusionHFMD poses a high economic and health burden in China. Our results provide economic and health utility data for cost-effectiveness analysis for HFMD vaccination in China.
Highlights
Hand, foot and mouth disease (HFMD) is an acute communicable disease caused by enteroviruses, most commonly enterovirus A71 (EV-A71) and coxsackie virus A16 (CV-A16). [1] Most HFMD cases are children under five years of age, with those younger than three years of age being the most susceptible.[2,3] HFMD has been the leading cause of morbidity among all nationally notifiable diseases since 2009 and become a major public health concern which is associated with a substantial burden of disease in China. [4,5]EV-A71 vaccines are the first vaccines developed against HFMD and became commercially available in China in 2016 [6]
Cases who were diagnosed with EV-A71 infection and had longer duration of illness were associated with higher total cost and quality-adjusted life years (QALY) loss
Our results provide economic and health utility data for cost-effectiveness analysis for HFMD vaccination in China
Summary
Foot and mouth disease (HFMD) is an acute communicable disease caused by enteroviruses, most commonly enterovirus A71 (EV-A71) and coxsackie virus A16 (CV-A16). [1] Most HFMD cases are children under five years of age, with those younger than three years of age being the most susceptible.[2,3] HFMD has been the leading cause of morbidity among all nationally notifiable diseases since 2009 and become a major public health concern which is associated with a substantial burden of disease in China. [4,5]EV-A71 vaccines are the first vaccines developed against HFMD and became commercially available in China in 2016 [6]. A key input for cost-effectiveness analysis is the economic costs and the effect on health-related quality of life (HRQoL) associated with HFMD. [8] The cost and HRQoL of HFMD patients in developed provinces are unlikely to be representative of those in less developed regions. To address this knowledge gap, we conducted a national telephone survey among caregivers of laboratory-confirmed HFMD cases who were registered in the national HFMD enhanced surveillance database to estimate the direct costs, indirect costs and quality-adjusted life years (QALY) lost associated with HFMD. The objective of this study is to assess the economic cost and healthrelated quality of life associated with HFMD in China.
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