Wodniak Natalie, Gharpure Radhika, Feng Luzhao, Lai Xiaozhan, Fang Hai, Tian Jianmei, Zhang Tao, Zhao Genming, Salcedo-Mejía Fernando, Alvis-Zakzuk Nelson J, Jara Jorge, Dawood Fatimah, Emukule Gideon O, Ndegwa Linus K, Sam I-Ching, Mend Tsogt, Jantsansengee Baigalmaa, Tempia Stefano, Cohen Cheryl, Walaza Sibongile, Kittikraisak Wanitchaya, Riewpaiboon Arthorn, Lafond Kathryn E, Mejia Nelly, Davis William W
Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
Influenza Other Respir Viruses. 2025 Jan;19(1):e70059. doi: 10.1111/irv.70059.
Seasonal influenza illness and acute respiratory infections can impose a substantial economic burden in low- and middle-income countries (LMICs). We assessed the cost of influenza illness and acute respiratory infections across household income strata.
We conducted a secondary analysis of data from a prior systematic review of costs of influenza and other respiratory illnesses in LMICs and contacted authors to obtain data on cost of illness (COI) for laboratory-confirmed influenza-like illness and acute respiratory infection. We calculated the COI by household income strata and calculated the out-of-pocket (OOP) cost as a proportion of household income.
We included 11 studies representing 11 LMICs. OOP expenses, as a proportion of annual household income, were highest among the lowest income quintile in 10 of 11 studies: in 4/4 studies among the general population, in 6/7 studies among children, 2/2 studies among older adults, and in the sole study for adults with chronic medical conditions. COI was generally higher for hospitalizations compared with outpatient illnesses; median OOP costs for hospitalizations exceeded 10% of annual household income among the general population and children in Kenya, as well as for older adults and adults with chronic medical conditions in China.
The findings indicate that influenza and acute respiratory infections pose a considerable economic burden, particularly from hospitalizations, on the lowest income households in LMICs. Future evaluations could investigate specific drivers of COI in low-income household and identify interventions that may address these, including exploring household coping mechanisms. Cost-effectiveness analyses could incorporate health inequity analyses, in pursuit of health equity.
季节性流感疾病和急性呼吸道感染会给低收入和中等收入国家（LMICs）带来巨大的经济负担。我们评估了不同家庭收入阶层的流感疾病和急性呼吸道感染的成本。
我们对之前关于LMICs流感和其他呼吸道疾病成本的系统评价数据进行了二次分析，并联系作者以获取实验室确诊的流感样疾病和急性呼吸道感染的疾病成本（COI）数据。我们按家庭收入阶层计算了COI，并将自付费用（OOP）作为家庭收入的一部分进行计算。
我们纳入了代表11个LMICs的11项研究。在11项研究中的10项中，自付费用占家庭年收入的比例在最低收入五分位数中最高：在4项针对普通人群的研究中、6项针对儿童的研究中、2项针对老年人的研究中以及唯一一项针对患有慢性疾病的成年人的研究中都是如此。与门诊疾病相比，住院的COI通常更高；在肯尼亚，普通人群和儿童中住院的自付费用中位数超过家庭年收入的10%，在中国，老年人和患有慢性疾病的成年人中也是如此。
研究结果表明，流感和急性呼吸道感染给LMICs中最低收入家庭带来了相当大的经济负担，尤其是住院费用。未来的评估可以调查低收入家庭中COI的具体驱动因素，并确定可能解决这些问题的干预措施，包括探索家庭应对机制。成本效益分析可以纳入健康公平性分析，以追求健康公平。
