Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Public Health England.
Statistics, Modelling and Economics Department, National Infection Service, Public Health England (PHE).
Clin Infect Dis. 2018 Aug 16;67(5):693-700. doi: 10.1093/cid/ciy167.
Norovirus places a substantial burden on healthcare systems, arising from infected patients, disease outbreaks, beds kept unoccupied for infection control, and staff absences due to infection. In settings with high rates of bed occupancy, opportunity costs arise from patients who cannot be admitted due to beds being unavailable. With several treatments and vaccines against norovirus in development, quantifying the expected economic burden is timely.
The number of inpatients with norovirus-associated gastroenteritis in England was modeled using infectious and noninfectious gastrointestinal Hospital Episode Statistics codes and laboratory reports of gastrointestinal pathogens collected at Public Health England. The excess length of stay from norovirus was estimated with a multistate model and local outbreak data. Unoccupied bed-days and staff absences were estimated from national outbreak surveillance. The burden was valued conventionally using accounting expenditures and wages, which we contrasted to the opportunity costs from forgone patients using a novel methodology.
Between July 2013 and June 2016, 17.7% (95% confidence interval [CI], 15.6%‒21.6%) of primary and 23.8% (95% CI, 20.6%‒29.9%) of secondary gastrointestinal diagnoses were norovirus attributable. Annually, the estimated median 290000 (interquartile range, 282000‒297000) occupied and unoccupied bed-days used for norovirus displaced 57800 patients. Conventional costs for the National Health Service reached £107.6 million; the economic burden approximated to £297.7 million and a loss of 6300 quality-adjusted life-years annually.
In England, norovirus is now the second-largest contributor of the gastrointestinal hospital burden. With the projected impact being greater than previously estimated, improved capture of relevant opportunity costs seems imperative for diseases such as norovirus.
诺如病毒给医疗系统带来了巨大负担，这是由感染患者、疾病暴发、因感染控制而空出的床位以及因感染而缺勤的员工造成的。在床位占用率较高的情况下，由于没有床位而无法入院的患者会产生机会成本。由于有几种针对诺如病毒的治疗方法和疫苗正在开发中，及时量化预期的经济负担非常重要。
使用传染性和非传染性胃肠道住院统计代码和英国公共卫生署收集的胃肠道病原体实验室报告，对英格兰诺如病毒相关肠胃炎的住院患者数量进行建模。使用多状态模型和本地暴发数据估计诺如病毒引起的额外住院时间。通过国家暴发监测估计空床日和员工缺勤情况。使用传统的会计支出和工资来衡量负担，我们使用一种新方法将其与因错失患者而产生的机会成本进行了对比。
在 2013 年 7 月至 2016 年 6 月期间，初级和二级胃肠道诊断中分别有 17.7%（95%置信区间[CI]，15.6%21.6%）和 23.8%（95%CI，20.6%29.9%）归因于诺如病毒。每年，估计有 290000 个（四分位间距，282000~297000）占用和未占用的床位用于治疗诺如病毒，导致 57800 名患者被转移。国民保健制度的常规成本达到 1.076 亿英镑；经济负担约为 2.977 亿英镑，每年损失 6300 个质量调整生命年。
在英格兰，诺如病毒现在是胃肠道住院负担的第二大原因。由于预计的影响比以前估计的更大，对于诺如病毒等疾病，似乎迫切需要更好地捕捉相关的机会成本。
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