Volume 25, Number 6—June 2019
Research
Assessment of Economic Burden of Concurrent Measles and Rubella Outbreaks, Romania, 2011–2012
Joseph Njau1, Denisa Janta, Aurora Stanescu, Sarah S. Pallas, Adriana Pistol, Nino Khetsuriani2, Susan Reef, Daniel Ciurea, Cassandra Butu, Aaron S. Wallace, and Laura Zimmerman
Table 3
Main analysis input and sensitivity analysis values used for cost analysis of economic burden of concurrent measles and rubella outbreaks, Romania, 2011–2012*
| Cost component | Disease | Input | Input value | Median (25th–75th percentiles) | Proportion (95% CI) | Sensitivity analysis LB | Sensitivity analysis UB |
|---|---|---|---|---|---|---|---|
| Case distribution | Measles | No. cases | 12,427 | NA | NA | 11,184 | 13,670 |
| Rubella | No. cases | 24,627 | NA | NA | 22,164 | 27,090 | |
| Rubella | No. CRS cases | 27 | NA | NA | NA | NA | |
| Rubella | Patients who died as of May 2016 | 12 | NA | NA | NA | NA | |
| Rubella | Patients who survived as of May 2016 | 15 | NA | NA | NA | NA | |
| Measles | Cases in 2011, % | 39 | NA | NA | NA | NA | |
| Measles | Cases in 2012, % | 61 | NA | NA | NA | NA | |
| Rubella | Cases in 2011, % | 16 | NA | NA | NA | NA | |
| Rubella | Cases in 2012, % | 85 | NA | NA | NA | NA | |
| Healthcare provider | Measles | Reimbursement to healthcare providers for diagnostic codes, 2011 | $1,313,049 | NA | NA | $1,181,744 | $1,444,353 |
| Measles | Reimbursement to healthcare providers for diagnostic codes, 2012 | $1,962,708 | NA | NA | $1,766,437 | $2,158,979 | |
| Rubella | Reimbursement to healthcare providers for diagnostic codes, 2011 | $107,494 | NA | NA | $96,745 | $118,244 | |
| Rubella | Reimbursement to healthcare providers for diagnostic codes, 2012 | $567,138 | NA | NA | $510,425 | $623,852 | |
| National outbreak response | Measles | Personnel time for outbreak response | $5,164 | NA | NA | $4,648 | $5,680 |
| Measles | Reagents/tests for outbreak response | $449,225 | NA | NA | $404,303 | $494,148 | |
| Measles | Emergency vaccine purchases | $61,962 | NA | NA | $55,766 | $68,158 | |
| Rubella | Personnel time for outbreak response | $10,437 | NA | NA | $9,393 | $11,481 | |
| Rubella | Reagents/tests for outbreak response | $907,951 | NA | NA | $817,156 | $998,746 | |
| Rubella | Emergency vaccine purchases | $125,235 | NA | NA | $112,712 | $137,759 | |
| Direct medical and nonmedical household | Measles | Out-of-pocket cost for inpatient care | NA | $66.87 ($21.27–$110.94) | NA | $21.27 | $110.94 |
| Rubella | Out-of-pocket cost for inpatient care | NA | $30.70 ($15.20–$82.06) | NA | $15.20 | $82.06 | |
| Measles | Out-of-pocket cost for outpatient care | NA | $18.23 ($4.55–$39.51) | NA | $4.55 | $39.51 | |
| Rubella | Out-of-pocket cost for outpatient care | NA | $12.50 ($6.07–$24.32) | NA | $6.07 | $24.32 | |
| Measles | Patients receiving outpatient care, % | NA | NA | 19 (24–60) | 24 | 60 | |
| Measles | Patients receiving inpatient care, % | NA | NA | 81 (80–109) | 80 | 100 | |
| Rubella | Patients receiving outpatient care, % | NA | NA | 62 (17–27) | 17 | 27 | |
| Rubella | Patients receiving inpatient care, % | NA | NA | 38 (24–91) | 34 | 91 | |
| Indirect household | Measles | Employment rate for case-patients and caregivers, % | 34 | NA | NA | NA | NA |
| Rubella | Employment rate for case-patients and caregivers, % | 32 | NA | NA | NA | NA | |
| Measles | No. work days missed by case-patients | NA | 11.45 (7–18) | NA | 7 | 18 | |
| Rubella | No. work days missed by case-patients | NA | 9.62 (7–14) | NA | 7 | 14 | |
| Measles | Case caregivers who missed work, % | 89 | NA | NA | NA | NA | |
| Rubella | Case caregivers who missed work, % | 68 | NA | NA | NA | NA | |
| Measles | No. work days missed by caregivers | NA | 7 (3–10) | NA | 3 | 10 | |
| Rubella | No. work days missed by caregivers | NA | 4.5 (3–7) | NA | 3 | 7 | |
| Both | Minimum daily wage | $10.44 | NA | NA | NA | NA | |
| CRS, direct medical | Rubella | Reimbursement to healthcare providers for patients who survived | NA | $6,455 ($1,749–$10,296) | NA | $1,749 | $10,296 |
| Rubella | Reimbursement to healthcare providers for patients who died | NA | $2,777 ($1,734–$3,309) | NA | $1,734 | $3,309 | |
| CRS, lifetime discounted indirect | Rubella | Minimum daily wage | $10.44 | NA | NA | NA | NA |
| Rubella | Years (range) of productivity loss | 46 (18–63) | NA | NA | NA | 74 (LE) | |
| Rubella | Labor force participation rate, % | 65 | NA | NA | NA | 100 | |
| Rubella | Unemployment rate, % | 11 | NA | NA | NA | 0 | |
| Rubella | Discount rate, % | 3 | NA | NA | NA | NA |
*Monetary values are in US 2013 dollars. CRS is an outcome of rubella. CRS, congenital rubella syndrome; LB, lower bound; LE, life expectancy; NA, not applicable; UB, upper bound.
1Current affiliation: JoDon Consulting Group LLC, Atlanta, Georgia, USA.
2Current affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Page created: May 20, 2019
Page updated: May 20, 2019
Page reviewed: May 20, 2019
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.