National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia.
Influenza Other Respir Viruses. 2013 Nov;7(6):1103-12. doi: 10.1111/irv.12138. Epub 2013 Jul 6.
Influenza and other respiratory infections cause excess winter morbidity in children. This study assessed the economic impact of influenza-like illness (ILI) on families with children attending childcare using a societal perspective.
We conducted a prospective cohort study in 90 childcare centres and one general practitioner clinics in Sydney, Australia, during 2010. Healthy children aged ≥6 months to <3 years were enrolled. Economic impacts of ILI (temperature ≥37·8°C or parental report of fever, plus ≥1 respiratory symptoms) were collected at 2 and 4 weeks after ILI onset by telephone interview. Parent-collected respiratory specimens were tested for respiratory viruses using real-time PCR (RT-PCR). Costs associated with healthcare visits, medication usage, carer time lost (work or recreation) and home care and/or additional childcare were collected. Influenza-like illness costs were described and further analysed using a Tobit model. Zero-inflated Poisson regression was employed to compare the numbers of healthcare visits for each ILI.
Of 381 children enrolled and analysed, 105 developed 124 ILIs. Specimens were available for 117 ILIs: five were positive by RT-PCR for A(H1N1)pdm09, 39 for adenovirus, 39 for rhinovirus, 15 for a coronavirus and 27 for a polyomavirus. The mean cost of all ILIs was AU$626 (95% confidence interval: AU$484-768) per ILI with no significant differences observed between viruses. Carers lost on average 13 hours of work and 3 hours of leisure time per ILI. Independent drivers of ILI costs were having both parents in employed work and longer duration of ILI. In multivariate analyses, four variables were significantly associated with an increased number of healthcare visits per ILI: non-Caucasian child, living in a detached house, both parents in employed work and having an ILI with one or more viruses identified.
For families with a child attending childcare, ILIs cause a substantial economic burden. An ILI in a child with working parents and/or with longer duration appears to cost more in monetary terms. Healthcare visits were increased if the child was non-Caucasian, lived in a detached house, had working parents or had a virus-positive ILI. Our findings on the estimates and determinants of economic impacts from respiratory virus infection highlight the importance and feasibility of an interdisciplinary (epidemiology/health economics) approach to such research.
流感和其他呼吸道感染会导致儿童在冬季的发病率增加。本研究从社会角度评估了儿童看护中心中儿童患流感样疾病(ILI)对家庭的经济影响。
我们在澳大利亚悉尼的 90 个儿童看护中心和 1 家全科医生诊所进行了一项前瞻性队列研究,纳入了年龄在 6 个月至<3 岁的健康儿童。在 ILI 发病后 2 周和 4 周通过电话访谈收集 ILI(体温≥37.8°C 或父母报告发热,加上≥1 项呼吸道症状)的经济影响。通过实时 PCR(RT-PCR)检测家长采集的呼吸道标本中的呼吸道病毒。收集与医疗就诊、药物使用、照顾者丧失的时间(工作或娱乐)、家庭护理和/或额外的儿童看护相关的费用。描述了 ILI 相关费用,并使用 Tobit 模型进一步分析。采用零膨胀泊松回归比较每次 ILI 的医疗就诊次数。
在纳入并分析的 381 名儿童中,有 105 名儿童发生了 124 次 ILI。117 次 ILI 可获得标本:5 次 RT-PCR 检测出 A(H1N1)pdm09 阳性,39 次检测出腺病毒阳性,39 次检测出鼻病毒阳性,15 次检测出冠状病毒阳性,27 次检测出多瘤病毒阳性。所有 ILI 的平均费用为 626 澳元(95%置信区间:484-768 澳元),不同病毒之间无显著差异。每次 ILI 平均每位照顾者丧失 13 小时工作时间和 3 小时休闲时间。ILI 费用的独立驱动因素为父母双方均从事有薪工作和 ILI 持续时间较长。在多变量分析中,有四个变量与每次 ILI 的医疗就诊次数增加显著相关:非白种人儿童、居住在独立式住宅、父母双方均从事有薪工作以及 ILI 存在一种或多种已鉴定的病毒。
对于有儿童在儿童看护中心的家庭来说,ILI 会造成巨大的经济负担。有工作的父母的儿童的 ILI 或持续时间较长的 ILI 在经济方面的花费似乎更多。如果儿童是非白种人、居住在独立式住宅、父母双方均从事有薪工作或患有病毒阳性 ILI,医疗就诊次数会增加。我们关于呼吸道病毒感染的经济影响的估计和决定因素的研究结果突出了采用跨学科(流行病学/健康经济学)方法进行此类研究的重要性和可行性。