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. 2019 Sep;13(5):484-495.
doi: 10.1111/irv.12650. Epub 2019 Jun 11.

Health and economic burden of influenza-associated illness in South Africa, 2013-2015

Stefano Tempia  1   2   3   4 , Jocelyn Moyes  3   5 , Adam L Cohen  1   2   6 , Sibongile Walaza  3   5 , Ijeoma Edoka  7 , Meredith L McMorrow  1   2 , Florette K Treurnicht  3 , Orienka Hellferscee  3   8 , Nicole Wolter  3   8 , Anne von Gottberg  3   8 , Athermon Nguweneza  3 , Johanna M McAnerney  3 , Halima Dawood  9   10 , Ebrahim Variava  11   12   13 , Cheryl Cohen  3   5
Affiliations

Health and economic burden of influenza-associated illness in South Africa, 2013-2015

Stefano Tempia et al. Influenza Other Respir Viruses. 2019 Sep.

Abstract

Background: Economic burden estimates are essential to guide policy-making for influenza vaccination, especially in resource-limited settings.

Methods: We estimated the cost, absenteeism, and years of life lost (YLL) of medically and non-medically attended influenza-associated mild and severe respiratory, circulatory and non-respiratory/non-circulatory illness in South Africa during 2013-2015 using a modified version of the World Health Organization (WHO) worksheet based tool for estimating the economic burden of seasonal influenza. Additionally, we restricted the analysis to influenza-associated severe acute respiratory illness (SARI) and influenza-like illness (ILI; subsets of all-respiratory illnesses) as suggested in the WHO manual.

Results: The estimated mean annual cost of influenza-associated illness was $270.5 million, of which $111.3 million (41%) were government-incurred costs, 40.7 million (15%) were out-of-pocket expenses, and $118.4 million (44%) were indirect costs. The cost of influenza-associated medically attended mild illness ($107.9 million) was 2.3 times higher than that of severe illness ($47.1 million). Influenza-associated respiratory illness costs ($251.4 million) accounted for 93% of the total cost. Estimated absenteeism and YLL were 13.2 million days and 304 867 years, respectively. Among patients with influenza-associated WHO-defined ILI or SARI, the costs ($95.3 million), absenteeism (4.5 million days), and YLL (65 697) were 35%, 34%, and 21% of the total economic and health burden of influenza.

Conclusion: The economic burden of influenza-associated illness was substantial from both a government and a societal perspective. Models that limit estimates to those obtained from patients with WHO-defined ILI or SARI substantially underestimated the total economic and health burden of influenza-associated illness.

Keywords: South Africa; economic burden; influenza; years of life lost.

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Conflict of interest statement

All authors declare that they have no commercial or other associations that may pose a conflict of interest.

Figures

Figure 1
Figure 1
Estimated mean annual proportional cost (in $) of influenza‐associated illness in South Africa during 2013‐2015 by: A, healthcare attendance; B, syndrome; and C, cost type
Figure 2
Figure 2
Estimated mean annual proportional number of absenteeism (in days) from influenza‐associated illness in South Africa during 2013‐2015 by: A, healthcare attendance; B, syndrome; and C, absenteeism type
See this image and copyright information in PMC

References

    1. Lafond KE, Nair H, Rasooly MH, et al. Global role and burden of influenza in pediatric respiratory hospitalizations, 1982–2012: a systematic analysis. PLoS Medicine. 2016;13(3):e1001977. - PMC - PubMed
    1. Iuliano AD, Roguski KM, Chang HH, et al. Estimates of global seasonal influenza‐associated respiratory mortality: a modelling study. Lancet. 2018;391(10127):1285‐1300. - PMC - PubMed
    1. Tempia S, Walaza S, Moyes J, et al. The effects of the attributable fraction and the duration of symptoms on burden estimates of influenza‐associated respiratory illnesses in a high HIV‐prevalence setting, South Africa, 2013–2015. Influenza Other Respir Viruses. 2018;12(3):360‐373. - PMC - PubMed
    1. Tempia S, Walaza S, Moyes J, et al. Factors for influenza‐associated severe acute respiratory illness hospitalization in South Africa, 2012–2015. Open Forum Infect Dis. 2017;4(1):ofw262. - PMC - PubMed
    1. Duque J, McMorrow ML, Cohen AL. Influenza vaccines and influenza antiviral drugs in Africa: are they available and do guidelines for their use exist? BMC Public Health. 2014;14:41. - PMC - PubMed

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