Original Article

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.

 

 

Sierra Moros MJ, Vázquez Torres M, Santa-Olalla Peralta P, Limia Sánchez A, Cortes García M, Pachón Del Amo I (2010). Ep-idemiological surveillance activities during the 2009 influenza pandemic in Spain: lessons learnt one year af¬ter. Rev Esp Salud Pública, 84(5): 463–79.

Larrauri Cámara A, Jiménez-Jorge S, Simón Mén¬dez L, de Mateo Ontañón S; Sistema de Vigi¬lancia de Gripe en España (SVGE) (2010). Surveillance of influenza pandemic (H1N1) 2009 in Spain. Rev Esp Salud Pública, 84(5): 569–88.

Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, Lindstrom S, Louie JK, Christ CM, Bohm SR, Fonseca VP, Ritger KA, Kuhles DJ, Eggers P, Bruce H, Davidson HA, Lutterloh E, Harris ML, Burke C, Cocoros N, Finelli L, MacFarlane KF, Shu B, Olsen SJ; Novel Influenza A (H1N1) Pregnancy Working Group (2009). H1N1 2009 influenza virus infec-tion during pregnancy in the USA. Lancet, 374(9688): 451-8.

Centers for Disease Control and Prevention (CDC) (2012). Pregnant women and novel in¬fluenza A (H1N1) virus: consid-erations for cli¬nicians. Available from: http://www.cdc.gov/h1n1flu/clinician_pregnant.htm

Santa-Olalla Peralta P, Cortes-García M, Vi-cente-Herrero M, Castrillo-Villamandos C, Arias-Bohigas P, Pachon-del Amo I, Sierra-Moros MJ, Surveillance Group for New Influenza A(H1N1) Virus Investiga-tion and Control Team in Spain (2010). Risk factors for disease severity among hospitalised patients with 2009 pandemic influenza A (H1N1) in Spain, April–December 2009. Euro Surveill, 15(38): 19667.

Simmerman JM, Lertiendumrong J, Dowell SF, Uyeki T, Olsen SJ, Chittaganpitch M, Chun¬sutthiwat S, Tangcharoensathien V (2006). The cost of influenza in Thailand. Vaccine, 24(20):4417-26.

Lambert SB, Allen KM, Carter RC, Nolan TM (2008). The cost of community-managed viral respiratory illnesses in a cohort of healthy pre¬school-aged chil-dren. Respir Res, 9: 11.

Schuchat A (2011). Reflections on pandem-ics, past and present. Am J Obstet Gynecol, 204(6 Suppl 1):S4-6.

Da Silva AA, Ranieri TM, Torres FD, Vianna FS, Paniz GR, Sanseverino PB, Picon PD, de Azevedo PB, Costa MH, Schuler-Faccini L, Sanseverino MT (2014). Impact on pregnancies in south Brazil from the influenza A (H1N1) pan-demic: cohort study. PLoS One, 9(2): e88624.

Ministerio de Sanidad, Servicios Sociales e Igual¬dad (2012). Información importante sobre la gripe A (H1N1). Available from: http://www.msssi.gob.es/servCiudadanos/alertas/gripeAH1N1.htm

Karageorgopoulos DE, Vouloumanou EK, Kor¬bila IP, Kapaskelis A, Falagas ME (2011). Age distribution of cases of 2009 (H1N1) pan¬demic Influenza in compari-son with seasonal influenza. PLoS One, 6(7): e21690.

Torá-Rocamora I, Delclos GL, Martínez JM, Jardí J, Alberti C, Manzanera R, Yasui Y, Clèries R, Tobías A, Benavides FG (2012). Occupational health impact of the 2009 H1N1 flu pandemic: surveillance of sickness absence. Occup Environ Med, 69(3): 205-10.

Smith RD, Keogh-Brown MR, Barnett T, Tait J (2009). The economy-wide impact of pan¬demic influenza on the UK: a computable gen¬eral equilibrium modelling experiment. BMJ, 339: b4571.

Brouwers L, Cakici B, Camitz M, Tegnell A, Bo¬man M (2009). Economic conse-quences to so¬ciety of pandemic H1N1 in-fluenza 2009 - pre¬liminary results for Sweden. Euro Surveill, 14(37): 19333.

Keogh-Brown MR, Smith RD, Edmunds JW, Beutels P (2010). The macroeconom-ic impact of pandemic influenza: esti-mates from models of the United King-dom, France, Belgium and The Nether-lands. Eur J Health Econ, 11(6): 543–54.

Domínguez A, Alonso J, Astray J, Baricot M, Cantón R, Castilla J, Castro A, Delga-do M, Godoy P, González-Candelas F, Martín V, Mayoral JM, Quintana JM, Pe-rea E, Pumarola T, Soldevila N, Tamames S, Grupo de Trabajo del Proyecto CIBE-RESP de Casos y Controles sobre la Gripe Pandémica (2011). Risk factors of Influenza (H1N1) 2009 hospi¬talization and effectiveness of pharmaceutical and nonpharmaceutical interventions in its prevention: a case-control study. Rev Esp Salud Pública, 85(1): 3-15.

Pachón J, Falguera M, Gudiol F, Sabriá M, Álva¬rez-Lerma F, Cordero E (2010). In-fecciones de las vías respiratorias Inferio-res. Available from:https://www.medicosporlaseguridadvial.com/temas-clinicos/enfermedades-respiratorias/infeccion-de-las-vias-respiratorias-inferiores-atelectasia-hemoptisis-y-su-influencia-en-la-conduccion/

Serrano-Herranz R (2010). Infecciones de las vías respiratorias Inferiores. Available from: https://www.fesemi.org/

Lynfield R, Davey R, Dwyer DE, Losso MH, Wentworth D, Cozzi-Lepri A, Her-man-Lamin K, Cholewinska G, David D, Kuetter S, Ternesgen Z, Uyeki TM, Lane HC, Lundgren J, Neaton JD; INSIGHT Influenza Study Group (2014). Outcomes of influenza A(H1N1)pdm09 virus infec-tion: results from two international co-hort studies. PLoS One, 9(7): e101785.

Hewagama S, Walker SP, Stuart RL, Gordon C, Johnson PD, Friedman ND, O'Reilly M, Cheng AC, Giles ML (2010). 2009 H1N1 influenza A and pregnancy out-comes in Victoria, Australia. Clin Infect Dis, 50 (5): 686-90.

Godoy P, Castilla J, Delgado-Rodríguez M et al. CIBERESP Cases and Controls in Pandemic Influenza Working Group, Spain (2012). Effectiveness of hand hy-giene and provision of information in pre¬venting influenza cases requiring hos-pitaliza¬tion. Prev Med, 54(6): 434-9.

Castilla J, Godoy P, Domínguez Á, Martín V, Delgado-Rodríguez M, Martínez-Baz I, Baricot M, Soldevila N, Mayoral JM, As-tray J, Quintana JM, Cantón R, Castro A, González-Candelas F, Alonso J, Saez M, Tamames S, Pumarola T; CIBERESP Ca-ses and Controls in Influenza Working Group (2013). Risk factors and effective-ness of preventive measures against influ-enza in the community. Influenza Other Respir Viruses. 7(2): 177-183.

Suh M, Kang DR, Lee DH, Choi YJ, Tchoe B, Nam CM, Kim HJ, Lee JK, Jun BY, Youm Y, Bae GN, Lee TY, Kim MS, Shin DC, Kim C (2013). Socioeconomic burden of influenza in the Republic of Korea, 2007-2010. PLos One, 8(12): e84121.

Galante M, Garin O, Sicuri E, Cots F, Gar-cía-Al¬tés A, Ferrer M, Dominguez À, Alonso J (2012). Health services utiliza-tion, work absen¬teeism and costs of pandemic influenza A (H1N1) 2009 in Spain: a multicenter-longitudi¬nal study. PLoS One, 7(2): e31696.

Vademecum. CMP Medicom Editorial, S.A. (2010). Available from: http://www.vademecum.es

Cots F, Chiarello P, García-Alzórriz E, Pe-láes E, Castells X, Raventós J (2010). Cost de l´activi¬tat asistencial. Variable de resultat per la gestió clínica. Fulls Econ, 39: 14-25

Instituto Nacional de Estadística (INE) (2010). Encuesta anual de coste laboral 2008. http://www.ine.es/prensa/np563.pdf.

Instituto Catalán de Salud (2010) RESOLU-CIÓN SLT/383/2009, de 21 de enero, sobre la revi¬sión de precios públicos co-rrespondientes a los servicios sanitarios que presta el Instituto Cata¬lán de la Salud. Diario Oficial de la Generalitat de Cata-lunya nº 5325. Available from: http://diario-oficial-generalitat-cata-lunya.vlex.es/vid/revision-precios-sanitarios-presta-81681102#

Concejalía de Sanidad (2010). Precios públi-cos por las prestaciones de los servicios y activida¬des de naturaleza sanitaria de la red de centros de la comunidad de Ma-drid. Boletín Oficial de la Comunidad de Madrid ORDEN 629/2009

Sander B, Bauch CT, Fisman D, Fowler RA, Kwong JC, Maetzel A, McGeer A, Raboud J, Scales DC, Gojovic MZ, Krahn M (2010). Is a mass immunization program for pandemic (H1N1) 2009 good value for money? Evi¬dence from the Canadian Experience. Vaccine, 28(38): 6210-20.

Burch J, Corbett M, Stock C, Nicholson K, Elliot AJ, Duffy S, Westwood M, Palmer S, Stewart L (2009). Prescription of anti-influenza drugs for healthy adults: a sys-tematic review and meta-analysis. Lancet Infect Dis, 9(9): 537-45

Gisbert JP, Cooper A, Karagiannis D, Hatlebakk J, Agréus L, Jablonowski H, Nuevo J (2009). Impact of gastroesopha-geal reflux disease on work absenteeism, presenteeism and produc¬tivity in daily life: a European observational study. Health Qual of Life Outcomes, 7: 90.

Fairbrother G, Cassedy A, Ortega-Sanchez IR, Szilagyi PG, Edwards KM, Molinari NA, Donauer S, Henderson D, Ambrose S, Kent D, Poehling K, Weinberg GA, Griffin MR, Hall CB, Finelli L, Bridges C, Staat MA, New Vaccine Surveillance Net-work (NVSN) (2010). High costs of in-fluenza: Di¬rect medical costs of influenza disease in young children. Vaccine, 28(31): 4913-9.

Donaldson LJ, Rutter PD, Ellis BM, Greaves FE, Mytton OT, Pebody RG, Yardley IE (2009). Mortality from pan-demic A/H1N1 2009 in¬fluenza in Eng-land: public health surveillance study. BMJ, 339: b5213.

Xue Y, Kristiansen IS, de Blasio BF (2010). Mod¬eling the cost of influenza: the im-pact of miss¬ing costs of unreported complications and sick leave. BMC Public Health, 10: 724.

Duncan B (2009). How the media reported the first days of the pandemic (H1N1) 2009: re¬sults of EU-wide media analysis. Euro Surveill, 14(30): 19286.

ANZIC Influenza Investigators, Webb SA, Pettilä V, Seppelt I, Bellomo R, Bailey M, Cooper DJ, Cretikos M, Davies AR, Fin-fer S, Harrigan PW, Hart GK, Howe B, Iredell JR, McArthur C, Mitchell I, Morri-son S, Nichol AD, Paterson DL, Peake S, Richards B, Stephens D, Turner A, Yung M (2009). Critical care services and 2009 H1N1 influenza in Australia and New Zea¬land. N Engl J Med, 361(20): 1925–34.

Fraser C, Donnelly CA, Cauchemez S et al. WHO Rapid Pandemic Assessment Col-labo¬ration (2009). Pandemic potential of a strain of influenza A (H1N1): early find-ings. Science, 324(5934): 1557-61.

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IssueVol 45 No 4 (2016) QRcode
SectionOriginal Article(s)
Keywords
Pandemic influenza A (H1N1) Costs Health services Pregnant women Spain

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MORALES-SUÁREZ-VARELA M, LLOPIS-GONZÁLEZ A, GONZÁLEZ-CANDELA F, ASTRAY J, ALONSO J, GARIN O, CASTRO A, GALAN JC, SOLDEVILA N, CASTILLA J, GO­DOYP, DELGADO-RODRÍGUEZ M, MARTIN V, MAYORAL JM, PUMAROLA T, QUINTANA JM, TAMAMES S, RUBIO-LÓPEZ N, DOMINGUEZ A. Economic Evaluation of Health Services Costs During Pandemic Influenza A (H1N1) Pdm09 Infection in Pregnant and Non-Pregnant Women in Spain. Iran J Public Health. 2016;45(4):423-434.