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Volume 5, Number 5—October 1999

Research

The Economic Impact of Pandemic Influenza in the United States: Priorities for Intervention

Martin I. MeltzerComments to Author , Nancy J. Cox, and Keiji Fukuda
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

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Table 3

Input variables used to calculate the economic impact (direct and indirect costs) of health outcomes due to an influenza pandemic in the United States (in 1995 US$)

Outcome category item Type of cost Age group (yrs)
Sources
0-19 20-64 65+
Deaths
Average age (years) 9 35 74 Assumed
PV earnings lost ($)a Indirect 1,016,101 1,037,673 65,837 16, 30
Most likely + min or maxhospital costs ($)b Direct 3,435 +2,632 7,605 +3,888 8,309 +3,692 Marketscan Database; 31.
Subtotal ($)c 1,019,536 1,045,278 74,146
Hospitalizations
Most likely + min or maxhospital costs ($)b Direct 2,936 +2,099 6,016 +2,086 6,856 +3,200 Marketscan Database; 31.
Most likely + min or max net pay for outpatient visits ($)d Direct 74 + 40 94 + 70 102 + 60 Marketscan Database; 31.
Avg. copayment for outpatient visit ($) Direct 5 4 4 Marketscan Database
Most likely + min or max net payment for drug claims($)e Direct 26 + 9 42 + 30 41 + 10 Marketscan Database
Most likely + min or max days lostf Indirect 5 + 2.7 8 + 4.8 10 +5.4 Marketscan Database; 31.
Value 1 day lost ($)g Indirect 65 100 or 65 65 30
Subtotal ($)c 3,366 6,842 7,653
Outpatient visits
Avg. no. visitsh Direct 1.52 1.52 1.52 Marketscan Database
Most likely + min or max net payment per visit($)i Direct 49 +13 38 + 12 50 + 16 Marketscan Database
Avg. copayment for outpatient visit ($) Direct 5 4 4 Marketscan Database
Most likely + min or max net payment per prescription($)j Direct 25 + 18 36 + 27 36 + 22 Marketscan Database
Avg. prescriptions per visit Direct 0.9 1.8 1.4 Marketscan Database
Avg. copayment per prescription ($) Direct 3 3 3 Marketscan Database
Days lost Indirect 3 2 5 4,5
Value 1 day lost ($)g Indirect 65 100 65 30
Subtotal ($)c 300 330 458
Ill, no medical care sought
Days lost Indirect 3 2 5 4,5
Value 1 day lost ($)g Indirect 65 100 65 30
Over-the-counter drugs ($) Direct 2 2 2 Assumed
Subtotal ($)c 197 202 327

aAverage present value (PV), using a 3% discount rate, of expected future lifetime earnings and housekeeping services, weighted by age and gender (30) and adjusted to 1995 dollars (by multiplying by a factor of 1.07) (16).
bMost likely, with + defining the minimum and maximum costs for a triangular distribution (18) for Monte Carlo analysis (13-15). The values were calculated by using cost data from Marketscan Database (The MEDSTAT Group, Ann Arbor, MI) and multiplying it by a hospital cost-to-charge ratio of 0.53. The latter ratio is a weighted average of the urban and rural (urban = 0.80, rural = 0.20) cost-to-charge ratios calculated by the Health Care Finance Administration for August 1996 (31).
cSubtotals are the totals for each category of outcome, using the most likely estimates.
dMost likely, with minimum and maximum values of net payments for outpatient visits up to 14 days before admission date and up to 30 days after discharge date.
eNet payment for drug claims associated with outpatient visits up to 14 days before admission and up to 30 days after discharge.
fMost likely, with + defining the minimum and maximum days lost due to hospitalization for a triangular distribution (18) for Monte Carlo analysis (13-15). Calculated using length of stay in hospital data from Marketscan Database (The MEDSTAT Group, Ann Arbor, MI) and adding a total of one additional day for convalescence and pre- and posthospitalization outpatient visits for 0-19 and 20-64 years of age. For 65 + years, two additional days were added to length of stay in hospital for convalescence and pre- and posthospitalization outpatient visits.
gFor 0-19 and 65+ years age groups, a day lost to influenza was valued as equivalent to an unspecified day (30), denoting a value for time lost by care givers and family members related to taking care of a patient in these age groups. For 20-64 years of age, 60% of days lost due to hospitalizations and related convalescence and pre- and posthospitalization outpatient visits were valued as day off work ($100/day). The remaining 40% of days lost were valued as unspecified days ($65/day). For 20-64 years of age, when patients were not hospitalized at any point during their illness (i.e., outpatient status), all days lost were assumed days off work ($100/day).
hThe number of visits per episode of influenza is an average across all age groups. From the database, it was found that 85% of all patients had less than three outpatient visits, with an average of 1.52 visits (Appendix 2).
iMost likely, with minimum and maximum values of net payments for outpatient visits without any specified association to hospitalizations.
jMost likely, with + defining the minimum and maximum cost per prescription, with the number of prescriptions per visit.

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