title: Economic Evaluation of Health Services Costs During Pandemic Influenza A (H1N1) Pdm09 Infection in Pregnant and Non-Pregnant Women in Spain.
abstract: BACKGROUND
  The healthcare and socio-economic burden resulting from influenza A (H1N1) pdm09 in Spain was considerable. Our aim was to estimate and compare the management (resource utilization) and economic healthcare impact in an at-risk group of unvaccinated pregnant women with an unvaccinated group of non-pregnant woman of childbearing age (15-44 yr old).
  
  
  METHODS
  We addressed this question with a longitudinal, observational, multicentre study. Inputs were the requirements in managing both groups of women. Outcome measures were healthcare costs. Direct healthcare (including medical utilisation, prescriptions of antivirals, medication, diagnostic tests, and hospitalisation) costs and indirect (productivity loss) costs were considered. Unit of cost was attributed to the frequency of health service resources utilisation. The mean cost per patient was calculated in this group of women.
  
  
  RESULTS
  We found that the influenza clinical pattern was worse in non-pregnant women as they had a high medical risk of 20.4% versus 6.1% of pregnant women. Non-pregnant required more antipyretics and antibiotics, and needed more health service resource utilisation (338 medical visits in non-pregnant women vs. 42 in pregnant women). The total cost of non-pregnant women was higher (€4,689.4/non-pregnant and €2,945.07/pregnant).
  
  
  CONCLUSIONS
  Cost per (H1N1) pdm09 was lower for pregnant women, probably due to more preventive measures adopted for their protection in Spain. The highest costs were incurred by hospitalisations/day and work absenteeism for non-pregnant than for pregnant women. These data will allow better future pandemic influenza planning.
authors.affiliation: Unit of Public Health, Hygiene and Environmental Health, Department of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, University of Valencia, 46010 Valencia, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Center for Public Health Research (CSISP-FISABIO), Valencia, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Morales-Suárez-Varela
authors.affiliation: Unit of Public Health, Hygiene and Environmental Health, Department of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, University of Valencia, 46010 Valencia, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Center for Public Health Research (CSISP-FISABIO), Valencia, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Llopis-González
authors.affiliation: CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Research Unit "Genomics and Health" CSISP-University of Valencia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: González-Candela
authors.affiliation: Surveillance Branch, Community of Madrid, Spain.
authors.forename: Jenaro
authors.initials: J
authors.lastname: Astray
authors.affiliation: CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; University Pompeu Fabra, Barcelona, Spain; Institute for Research IMIM-Hospital del Mar, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.affiliation: CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; University Pompeu Fabra, Barcelona, Spain; Institute for Research IMIM-Hospital del Mar, Spain.
authors.forename: Olatz
authors.initials: O
authors.lastname: Garin
authors.affiliation: CIBER Respiratory Diseases, Spain.
authors.forename: Ady
authors.initials: A
authors.lastname: Castro
authors.affiliation: CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Galan
authors.affiliation: CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; University of Girona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Soldevila
authors.affiliation: CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Public Health Institute of Navarra, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Castilla
authors.affiliation: CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Dept. of Health, Generalitat of Catalonia, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Godoy
authors.affiliation: CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; University of Jaen, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Delgado-Rodríguez
authors.affiliation: CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; University of León, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Martin
authors.affiliation: Security Service of Andalusia, Spain.
authors.forename: Jose María
authors.initials: JM
authors.lastname: Mayoral
authors.affiliation: Red Española de Investigación en Patología Infecciosa (REIPI), Spain.
authors.forename: Tomas
authors.initials: T
authors.lastname: Pumarola
authors.affiliation: CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Basque Fundation for Health Innovation and Research, Spain.
authors.forename: José Maria
authors.initials: JM
authors.lastname: Quintana
authors.affiliation: Dept. of Public Health, Development and Innovation, Junta de Castilla y León, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Tamames
authors.affiliation: Unit of Public Health, Hygiene and Environmental Health, Department of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, University of Valencia, 46010 Valencia, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Center for Public Health Research (CSISP-FISABIO), Valencia, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Rubio-López
authors.affiliation: CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Dept. of Public Health, University of Barcelona, Spain.
authors.forename: Angela
authors.initials: A
authors.lastname: Dominguez
keywords: Costs; Health services; Pandemic influenza A (H1N1); Pregnant women; Spain