The Clinical and Economic Burden of Norovirus Gastroenteritis in the United States

Abstract Background Although norovirus outbreaks periodically make headlines, it is unclear how much attention norovirus may receive otherwise. A better understanding of the burden could help determine how to prioritize norovirus prevention and control. Methods We developed a computational simulation model to quantify the clinical and economic burden of norovirus in the United States. Results A symptomatic case generated $48 in direct medical costs, $416 in productivity losses ($464 total). The median yearly cost of outbreaks was $7.6 million (range across years, $7.5–$8.2 million) in direct medical costs, and $165.3 million ($161.1–$176.4 million) in productivity losses ($173.5 million total). Sporadic illnesses in the community (incidence, 10–150/1000 population) resulted in 14 118–211 705 hospitalizations, 8.2–122.9 million missed school/work days, $0.2–$2.3 billion in direct medical costs, and $1.4–$20.7 billion in productivity losses ($1.5–$23.1 billion total). The total cost was $10.6 billion based on the current incidence estimate (68.9/1000). Conclusion Our study quantified norovirus’ burden. Of the total burden, sporadic cases constituted >90% (thus, annual burden may vary depending on incidence) and productivity losses represented 89%. More than half the economic burden is in adults ≥45, more than half occurs in winter months, and >90% of outbreak costs are due to person-to-person transmission, offering insights into where and when prevention/control efforts may yield returns. We estimate that norovirus costs $10.6 billion annually, based on the latest US incidence estimate. Sporadic community cases represented >90% and productivity losses 89% of the total burden, with more than half the burden in adults aged ≥45 years.