Economic burden of influenza‐associated hospitalizations and outpatient visits in Bangladesh during 2010

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. Design 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.