Cost of an Outbreak of Hepatitis A in Puglia, Italy

Abstract

In total, 5889 cases of hepatitis A virus infection were reported during an outbreak in Puglia, a region of Southern Italy, in 1996. The primary cause of the outbreak was consumption of contaminated food (raw shellfish, vegetables, etc.), with a contributory risk factor of person-to-person transmission. A detailed questionnaire was completed by 250 randomly selected patients to obtain information sufficient to calculate the direct and indirect costs of the outbreak for the individual patient, the National Health Service (NHS) and society as a whole. A conversion rate of $US1 = 1530 Italian lire (L) has been used throughout the study since this was the average exchange rate in 1996. For the individual patient with hepatitis A virus infection, the mean cost was L1.013 million ($US662), which was equivalent to 6.6% of the mean annual income of the employed patients. The total cost of the outbreak to the NHS was L23.98 billion ($US15.67 million), which was equivalent to 0.4% of the total public health expenditure in the region in 1996. The total cost of the outbreak to society (individual patient, NHS and third parties combined) was L37.406 billion ($US24.45 million), corresponding to 0.04% of the gross domestic product of the entire region in 1996, with a mean cost per patient of L6.35 million ($US4150) from a societal perspective. The majority of patients (86.3%) were 11 to 30 years of age, reflecting the increasing susceptibility of younger patients to hepatitis A virus infection in recent decades. These economic and demographic data provide important information for the evaluation of preventive strategies including public education, sanitation and immunisation, so as to optimise the use of local health resources.

Hepatitis A in Latin America: a changing epidemiologic pattern.

“…21,22 Recently, the economic burden of a community-wide hepatitis A outbreak was calculated in Puglia, Italy. 23 Costs were calculated to be 662 US $ for the individual patient, whereas total societal costs amounted to 24.45 million US $ for the 5,889 cases of hepatitis A monitored during this outbreak in Italy. Currently, a study surveying mortality and morbidity caused by hepatitis A virus infections is ongoing and a health economics study is planned in several Latin American countries.…”

Rapid Increase in the National Treatment Costs for Hepatitis A Infections in Korea

“…Hospitalization costs accounted for 91.4% of total treatment costs, a higher percentage than that found in previous studies (61-84%) (Lucioni et al 1998;Bownds et al 2003;Sansom et al 2003). Thus, attention must be paid to the fact that recent service utilization of patients with hepatitis A has centered on inpatient care and that total treatment costs are increasing due to the increase in hospitalization costs.…”

“…Reliable analyses of treatment costs or economic burden are necessary to develop an appropriate disease management strategy for hepatitis A. Although studies analyzing the economic burden or the treatment costs for hepatitis A have been conducted in some developed countries (Dalton et al 1996;Demicheli et al 1996;Lucioni et al 1998;Bownds et al 2003;Sansom et al 2003;Artega et al 2009), most are not representative, because they used partial data from specific locations or medical institutions rather than nationwide data. Moreover, those studies conducted a limited analysis of medical service utilization and treatment costs associated with the characteristics of patients.…”

An individual-based model of hepatitis A transmission

“…Although this is true also for Italy as a whole, as documented by both notification (Mele et al, 2006;ISTAT, 1980ISTAT, -2006 Italy, where a very large outbreak was observed in 1996-1997 (Lucioni et al, 1998), despite the improvement of socio-economic conditions.…”

“…Nevertheless, viral hepatitis A represents an important public health issue, imposing a remarkable economic burden worldwide (Berge et al, 2000;Das, 2003) and in Italy as well (Lucioni et al, 1998).…”