Abstract
BackgroundEconomic burden estimates are essential to guide policy‐making for influenza vaccination, especially in resource‐limited settings.MethodsWe estimated the cost, absenteeism, and years of life lost (YLL) of medically and non‐medically attended influenza‐associated mild and severe respiratory, circulatory and non‐respiratory/non‐circulatory illness in South Africa during 2013‐2015 using a modified version of the World Health Organization (WHO) worksheet based tool for estimating the economic burden of seasonal influenza. Additionally, we restricted the analysis to influenza‐associated severe acute respiratory illness (SARI) and influenza‐like illness (ILI; subsets of all‐respiratory illnesses) as suggested in the WHO manual.ResultsThe estimated mean annual cost of influenza‐associated illness was $270.5 million, of which $111.3 million (41%) were government‐incurred costs, 40.7 million (15%) were out‐of‐pocket expenses, and $118.4 million (44%) were indirect costs. The cost of influenza‐associated medically attended mild illness ($107.9 million) was 2.3 times higher than that of severe illness ($47.1 million). Influenza‐associated respiratory illness costs ($251.4 million) accounted for 93% of the total cost. Estimated absenteeism and YLL were 13.2 million days and 304 867 years, respectively. Among patients with influenza‐associated WHO‐defined ILI or SARI, the costs ($95.3 million), absenteeism (4.5 million days), and YLL (65 697) were 35%, 34%, and 21% of the total economic and health burden of influenza.ConclusionThe economic burden of influenza‐associated illness was substantial from both a government and a societal perspective. Models that limit estimates to those obtained from patients with WHO‐defined ILI or SARI substantially underestimated the total economic and health burden of influenza‐associated illness.
Highlights
Economic burden estimates are essential to guide policy‐making for in‐ fluenza vaccination, especially in resource‐limited settings
We considered the cost of influenza‐associated illness in three categories as follows: (a) direct medical costs: costs related to treat‐ ment incurred both within and outside health facilities; (b) direct non‐medical costs: illness‐re‐ lated expenditures that do not relate directly to medical treatment; and (c) indirect costs: the value of lost productivity because of reduced working time during the illness episode or while receiving care
We reported the economic burden of influenza‐associated illness per capita and as a propor‐ tion of the gross domestic product (GDP) for comparison with other studies globally
Summary
We estimated the economic burden from a societal perspective. Costs in South African Rands were converted to 2015 US dollar using average monthly South African Rand to US dollar exchange rate in 2015. In the main analysis for medically attended severe illness, data on quantities of resources used during hospitalization were obtained from influenza‐positive patients hospitalized with SARI (ie, number of admissions to ICU, chest X‐rays, oxygen therapy, medications, and laboratory tests—DS3 in Table 1 and Appendix S1) through routine influenza surveillance conducted in seven public hospitals across the country. Routine service costs and ancillary costs were summed to obtain the mean total cost of influenza‐associated SARI hospitali‐ zation per episode This figure was multiplied by national estimates of the number of influenza‐associated severe illness episodes (ob‐ tained from DS1 and DS2 in Table 1 and Appendix S1) across the syn‐ dromes evaluated in this study (ie, acute‐respiratory, all‐respiratory, all‐circulatory, and non‐respiratory/non‐circulatory). YLL was estimated for all influenza‐associ‐ ated deaths as well as for influenza‐associated SARI deaths
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