title: Indirect, out-of-pocket and medical costs from influenza-related illness in young children.
abstract: BACKGROUND
  Studies have documented direct medical costs of influenza-related illness in young children, however little is known about the out-of-pocket and indirect costs (e.g., missed work time) incurred by caregivers of children with medically attended influenza.
  
  
  OBJECTIVE
  To determine the indirect, out-of-pocket (OOP), and direct medical costs of laboratory-confirmed medically attended influenza illness among young children.
  
  
  METHODS
  Using a population-based surveillance network, we evaluated a representative group of children aged <5 years with laboratory-confirmed, medically attended influenza during the 2003-2004 season. Children hospitalized or seen in emergency department (ED) or outpatient settings in surveillance counties with laboratory-confirmed influenza were identified and data were collected from medical records, accounting databases, and follow-up interviews with caregivers. Outcome measures included work time missed, OOP expenses (e.g., over-the-counter medicines, travel expenses), and direct medical costs. Costs were estimated (in 2009 US Dollars) and comparisons were made among children with and without high risk conditions for influenza-related complications.
  
  
  RESULTS
  Data were obtained from 67 inpatients, 121 ED patients and 92 outpatients with laboratory-confirmed influenza. Caregivers of hospitalized children missed an average of 73 work hours (estimated cost $1456); caregivers of children seen in the ED and outpatient clinics missed 19 ($383) and 11 work hours ($222), respectively. Average OOP expenses were $178, $125 and $52 for inpatients, ED-patients and outpatients, respectively. OOP and indirect costs were similar between those with and without high risk conditions (p>0.10). Medical costs totaled $3990 for inpatients and $730 for ED-patients.
  
  
  CONCLUSIONS
  Out-of-pocket and indirect costs of laboratory-confirmed and medically attended influenza in young children are substantial and support the benefits of vaccination.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. IOrtegaSanchez@cdc.gov
authors.forename: Ismael R
authors.initials: IR
authors.lastname: Ortega-Sanchez
authors.forename: Noelle-Angelique M
authors.initials: NA
authors.lastname: Molinari
authors.forename: Gerry
authors.initials: G
authors.lastname: Fairbrother
authors.forename: Peter G
authors.initials: PG
authors.lastname: Szilagyi
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Edwards
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
authors.forename: Amy
authors.initials: A
authors.lastname: Cassedy
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Poehling
authors.forename: Carolyn
authors.initials: C
authors.lastname: Bridges
authors.forename: Mary Allen
authors.initials: MA
authors.lastname: Staat
mesh_terms: D002675:Child, Preschool; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000191:economics*; D007407:Interviews as Topic; D008297:Male; D014481:United States