Lambert Stephen B, Allen Kelly M, Carter Robert C, Nolan Terence M
Vaccine and Immunisation Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, and School of Population Health, University of Melbourne, Melbourne, Victoria, Australia.
Respir Res. 2008 Jan 24;9(1):11. doi: 10.1186/1465-9921-9-11.
Acute respiratory illnesses (ARIs) during childhood are often caused by respiratory viruses, result in significant morbidity, and have associated costs for families and society. Despite their ubiquity, there is a lack of interdisciplinary epidemiologic and economic research that has collected primary impact data, particularly associated with indirect costs, from families during ARIs in children.
We conducted a 12-month cohort study in 234 preschool children with impact diary recording and PCR testing of nose-throat swabs for viruses during an ARI. We used applied values to estimate a virus-specific mean cost of ARIs.
Impact diaries were available for 72% (523/725) of community-managed illnesses between January 2003 and January 2004. The mean cost of ARIs was AU$309 (95% confidence interval $263 to $354). Influenza illnesses had a mean cost of $904, compared with RSV, $304, the next most expensive single-virus illness, although confidence intervals overlapped. Mean carer time away from usual activity per day was two hours for influenza ARIs and between 30 and 45 minutes for all other ARI categories.
From a societal perspective, community-managed ARIs are a significant cost burden on families and society. The point estimate of the mean cost of community-managed influenza illnesses in healthy preschool aged children is three times greater than those illnesses caused by RSV and other respiratory viruses. Indirect costs, particularly carer time away from usual activity, are the key cost drivers for ARIs in children. The use of parent-collected specimens may enhance ARI surveillance and reduce any potential Hawthorne effect caused by compliance with study procedures. These findings reinforce the need for further integrated epidemiologic and economic research of ARIs in children to allow for comprehensive cost-effectiveness assessments of preventive and therapeutic options.
儿童期急性呼吸道疾病（ARIs）通常由呼吸道病毒引起，会导致严重发病，并给家庭和社会带来相关成本。尽管这些疾病普遍存在，但缺乏跨学科的流行病学和经济学研究，来收集儿童急性呼吸道疾病期间家庭的主要影响数据，尤其是与间接成本相关的数据。
我们对234名学龄前儿童进行了为期12个月的队列研究，在急性呼吸道疾病期间用影响日记记录情况，并对鼻咽拭子进行病毒PCR检测。我们使用应用价值来估计特定病毒引起的急性呼吸道疾病的平均成本。
在2003年1月至2004年1月期间，72%（523/725）的社区管理疾病有影响日记记录。急性呼吸道疾病的平均成本为309澳元（95%置信区间为263澳元至354澳元）。流感疾病的平均成本为904澳元，而呼吸道合胞病毒（RSV）引起的疾病平均成本为304澳元，是第二昂贵的单一病毒引起的疾病，尽管置信区间有重叠。流感急性呼吸道疾病护理人员每天平均离开日常活动的时间为两小时，而所有其他急性呼吸道疾病类别则为30至45分钟。
从社会角度来看，社区管理的急性呼吸道疾病给家庭和社会带来了巨大的成本负担。健康学龄前儿童社区管理的流感疾病平均成本的点估计值，是呼吸道合胞病毒及其他呼吸道病毒引起疾病的三倍。间接成本，尤其是护理人员离开日常活动的时间，是儿童急性呼吸道疾病的关键成本驱动因素。使用家长采集的样本可能会加强急性呼吸道疾病监测，并减少因遵守研究程序而产生的任何潜在霍桑效应。这些发现强化了对儿童急性呼吸道疾病进行进一步综合流行病学和经济学研究的必要性，以便对预防和治疗方案进行全面的成本效益评估。
