Health Services Utilization, Work Absenteeism and Costs of Pandemic Influenza A (H1N1) 2009 in Spain: A Multicenter-Longitudinal Study

Background: The aim of this study was to estimate healthcare resource utilization, work absenteeism and cost per patient with pandemic influenza (H1N1)2009, from its beginning to March 2010, in Spain. We also estimated the economic impact on healthcare services. Methods and Findings: Longitudinal, descriptive,multicenter study of in- and outpatients with confirmed diagnosis of influenza A (H1N1) in Spain. Temporal distribution of cases was comparable to that in Spain. Information of healthcare and social resources used from one week before admission (inpatient) or index-medical visit (outpatient) until recovery was gathered. Unit cost was imputed to utilization frequency for the monetary valuation of use. Mean cost per patient was calculated. A sensitivity analysis was conducted, and variables correlated with cost per patient were identified. Economic impact on the healthcare system was estimated using healthcare costs per patient and both, the reported number of confirmed and clinical cases in Spain. 172 inpatients and 224 outpatients were included. Less than 10% were over 65 years old and more than 50% had previous comorbidities. 12.8% of inpatients were admitted to the Intensive Care Unit. Mean length of hospital stay of patients not requiring critical care was 5 days (SD =4.4). All working-inpatients and 91.7% working-outpatients went on sick leave. On average, work absenteeism was 30.5 days (SD=20.7) for the first ones and 9 days (SD= 6.3) for the latest. Caregivers of 21.7% of inpatients and 8.5% of outpatients also had work absenteeism during 10.7 and 4.1 days on average respectively. Mean cost was J6,236/inpatient (CI95%=1,384-14,623) and J940/outpatient (CI95% =66-3,064). The healthcare economic burden of patients with confirmed influenza was J144,773,577 (IC95% 13,753,043-383,467,535). More than 86% of expenditures were a result of outpatients" utilization. Conclusion: Cost per H1N1-patient did not defer much from seasonal influenza estimates. Hospitalizations and work absenteeism represented the highest cost per patient

Parental knowledge of paediatric vaccination

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Atherosclerosis, Cardiovascular Disease, and COVID-19: A Narrative Review

Atherosclerosis is a chronic inflammatory and degenerative process that mainly occurs in large- and medium-sized arteries and is morphologically characterized by asymmetric focal thickenings of the innermost layer of the artery, the intima. This process is the basis of cardiovascular diseases (CVDs), the most common cause of death worldwide. Some studies suggest a bidirectional link between atherosclerosis and the consequent CVD with COVID-19. The aims of this narrative review are (1) to provide an overview of the most recent studies that point out a bidirectional relation between COVID-19 and atherosclerosis and (2) to summarize the impact of cardiovascular drugs on COVID-19 outcomes. A growing body of evidence shows that COVID-19 prognosis in individuals with CVD is worse compared with those without. Moreover, various studies have reported the emergence of newly diagnosed patients with CVD after COVID-19. The most common treatments for CVD may influence COVID-19 outcomes. Thus, their implication in the infection process is briefly discussed in this review. A better understanding of the link among atherosclerosis, CVD, and COVID-19 could proactively identify risk factors and, as a result, develop strategies to improve the prognosis for these patients

Mean cost per patient and its 95%CI based on the sensitivity analysis.

<p>Mean cost per patient and its 95%CI based on the sensitivity analysis.</p

Correlation of cost per patient and the main input variables (Spearman's rank).

<p>A. Inpatients. B. Outpatient. Abbreviations: GW: General Ward, ICU: Intensive Care Unit, GP: General Practitioner, ED: Emergency Department.</p

Sample selection flow chart.

<p>Sample selection flow chart.</p

Unit costs of healthcare and social¹ resources: sources of information and calculation method.

<p>GP: General Practitioner; ED: Emergency Department; CT: Computed Tomography; ICU: Intensive Care Unit; GW: General Ward; DOGC: Diari Oficial Generalitat de Catalunya (Departament de Salut, Resolución SLT/383/2009); BoMA: Boletín Oficial de Madrid (Conserjeria de Salud y Consumo), Order 629/2009); Expert: expert in occupational health; Mass media: pandemic vaccine prices published in “El País” newspaper available at <a href="http://www.elpais.com/articulo/sociedad/Francia/vende/excedente/vacunas/gripe/elpepusoc/20100104elpepisoc_4/Tes" target="_blank">http://www.elpais.com/articulo/sociedad/Francia/vende/excedente/vacunas/gripe/elpepusoc/20100104elpepisoc_4/Tes</a> Vademecum: Vademecum.es. CMP Medicom Editorial, S.A.; H. Clinic: price list of the Hospital Clínic de Barcelona; PSMar: clinical costing system of Parc de Salut Mar. INE: National Institute of Statistics.</p>1<p>Social resources analysed in this study included work absenteeism of patients and caregivers and paid-caregiver requirement.</p><p> <b>Methods for unit cost calculation:</b></p>2<p>Mean cost of available information.</p>3<p>Published cost, price or reimbursement tariff.</p>4<p>Mean of Recommended Retail Price of the different brands available.</p>5<p>Actual cost calculated from price lists applying the correspondent discount.</p>6<p>Mean costs per day of hospitalization of inpatients with pandemic influenza A (H1N1) admitted to the Hospital del Mar during the same period.</p

Direct healthcare and indirect¹ costs' distribution according to patient's group.

<p>¹Indirect cost is derived from work absenteeism of patient and caregiver and paid caregiver. A. Inpatients admitted to the intensive care unit at any time of the hospitalization. (n = 20). B. Inpatients hospitalized exclusively at the general ward. (n = 136). C. Outpatients. (n = 224).</p

Statistical characteristics of the input variables included at the multivariate probabilistic sensitivity analysis.

<p>GP: general practitioner; ED: emergency department.</p><p>Geometric distribution parameter: p (probability of success in each trial).</p><p>Uniform distribution parameters: minimum, maximum.</p><p>Negative Binomial parameters: s - p (s = mean number of successes, p = probability of success in each trial).</p><p>Binomial parameters: n - p (n = number of trials, p = probability of success in each trial).</p><p>Beta General Distribution parameters: alpha1- alpha2 – minimum - maximum (alpha1 and alpha 2 = shape parameters).</p><p>Poisson parameter: λ (λ = mean number of success).</p>1<p>no variability was introduced to these inputs due to lack of alternative unit cost information availability.</p

Patients' characteristics.

1<p>Among 77 inpatients and 75 outpatients who we recruited after the pandemic (H1N1) 2009 vaccine was available in Spain (16^th November 2009).</p