title: Economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh during 2010.
abstract: OBJECTIVE
  Understanding the costs of influenza-associated illness in Bangladesh may help health authorities assess the cost-effectiveness of influenza prevention programs. We estimated the annual economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh.
  
  
  METHODS
  From May through October 2010, investigators identified both outpatients and inpatients at four tertiary hospitals with laboratory-confirmed influenza infection through rRT-PCR. Research assistants visited case-patients' homes within 30 days of hospital visit/discharge and administered a structured questionnaire to capture direct medical costs (physician consultation, hospital bed, medicines and diagnostic tests), direct non-medical costs (food, lodging and travel) and indirect costs (case-patients' and caregivers' lost income). We used WHO-Choice estimates for routine healthcare service costs. We added direct, indirect and healthcare service costs to calculate cost-per-episode. We used median cost-per-episode, published influenza-associated outpatient and hospitalization rates and Bangladesh census data to estimate the annual economic burden of influenza-associated illnesses in 2010.
  
  
  RESULTS
  We interviewed 132 outpatients and 41 hospitalized patients. The median cost of an influenza-associated outpatient visit was US$4.80 (IQR = 2.93-8.11) and an influenza-associated hospitalization was US$82.20 (IQR = 59.96-121.56). We estimated that influenza-associated outpatient visits resulted in US$108 million (95% CI: 76-147) in direct costs and US$59 million (95% CI: 37-91) in indirect costs; influenza-associated hospitalizations resulted in US$1.4 million (95% CI: 0.4-2.6) in direct costs and US$0.4 million (95% CI: 0.1-0.8) in indirect costs in 2010.
  
  
  CONCLUSIONS
  In Bangladesh, influenza-associated illnesses caused an estimated US$169 million in economic loss in 2010, largely driven by frequent but low-cost outpatient visits.
authors.affiliation: icddr,b, Centre for Communicable Diseases, Dhaka, Bangladesh.
authors.forename: Mejbah U
authors.initials: MU
authors.lastname: Bhuiyan
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
authors.forename: Nadia I
authors.initials: NI
authors.lastname: Alamgir
authors.forename: Nusrat
authors.initials: N
authors.lastname: Homaira
authors.forename: Abdullah A
authors.initials: AA
authors.lastname: Mamun
authors.forename: Jahangir A M
authors.initials: JA
authors.lastname: Khan
authors.forename: Jaynal
authors.initials: J
authors.lastname: Abedin
authors.forename: Katharine
authors.initials: K
authors.lastname: Sturm-Ramirez
authors.forename: Emily S
authors.initials: ES
authors.lastname: Gurley
authors.forename: Rashid U
authors.initials: RU
authors.lastname: Zaman
authors.forename: A S M
authors.initials: AS
authors.lastname: Alamgir
authors.forename: Mahmudur
authors.initials: M
authors.lastname: Rahman
authors.forename: Marc-Alain
authors.initials: MA
authors.lastname: Widdowson
authors.forename: Eduardo
authors.initials: E
authors.lastname: Azziz-Baumgartner
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics*; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000191:economics* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009975:Orthomyxoviridae / Q000302:isolation & purification*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Bangladesh; cost; hospitalization; influenza; outpatient
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