title: The cost of community-managed viral respiratory illnesses in a cohort of healthy preschool-aged children.
abstract: BACKGROUND
  Acute respiratory illnesses (ARIs) during childhood are often caused by respiratory viruses, result in significant morbidity, and have associated costs for families and society. Despite their ubiquity, there is a lack of interdisciplinary epidemiologic and economic research that has collected primary impact data, particularly associated with indirect costs, from families during ARIs in children.
  
  
  METHODS
  We conducted a 12-month cohort study in 234 preschool children with impact diary recording and PCR testing of nose-throat swabs for viruses during an ARI. We used applied values to estimate a virus-specific mean cost of ARIs.
  
  
  RESULTS
  Impact diaries were available for 72% (523/725) of community-managed illnesses between January 2003 and January 2004. The mean cost of ARIs was AU$309 (95% confidence interval $263 to $354). Influenza illnesses had a mean cost of $904, compared with RSV, $304, the next most expensive single-virus illness, although confidence intervals overlapped. Mean carer time away from usual activity per day was two hours for influenza ARIs and between 30 and 45 minutes for all other ARI categories.
  
  
  CONCLUSIONS
  From a societal perspective, community-managed ARIs are a significant cost burden on families and society. The point estimate of the mean cost of community-managed influenza illnesses in healthy preschool aged children is three times greater than those illnesses caused by RSV and other respiratory viruses. Indirect costs, particularly carer time away from usual activity, are the key cost drivers for ARIs in children. The use of parent-collected specimens may enhance ARI surveillance and reduce any potential Hawthorne effect caused by compliance with study procedures. These findings reinforce the need for further integrated epidemiologic and economic research of ARIs in children to allow for comprehensive cost-effectiveness assessments of preventive and therapeutic options.
authors.affiliation: Vaccine and Immunisation Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, and School of Population Health, University of Melbourne, Melbourne, Victoria, Australia. sblambert@uq.edu.au
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Lambert
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Allen
authors.forename: Robert C
authors.initials: RC
authors.lastname: Carter
authors.forename: Terence M
authors.initials: TM
authors.lastname: Nolan
mesh_terms: D000553:Ambulatory Care / Q000191:economics; D001315:Australia; D002675:Child, Preschool; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000191:economics; D008297:Male; D008499:Medical Records; D018357:Respiratory Syncytial Virus Infections / Q000191:economics; D012141:Respiratory Tract Infections / Q000191:economics* / Q000628:therapy / Q000821:virology; D012648:Self Care / Q000191:economics; D014777:Virus Diseases / Q000191:economics*