Economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh during 2010

Mejbah U Bhuiyan, Stephen P Luby, Nadia I Alamgir, Nusrat Homaira, Abdullah A Mamun, Jahangir A M Khan, Jaynal Abedin, Katharine Sturm-Ramirez, Emily S Gurley, Rashid U Zaman, A S M Alamgir, Mahmudur Rahman, Marc-Alain Widdowson, Eduardo Azziz-Baumgartner

Research output: Contribution to journalA1: Web of Science-articlepeer-review


OBJECTIVE: Understanding the costs of influenza-associated illness in Bangladesh may help health authorities assess the cost-effectiveness of influenza prevention programs. We estimated the annual economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh.

DESIGN: From May through October 2010, investigators identified both outpatients and inpatients at four tertiary hospitals with laboratory-confirmed influenza infection through rRT-PCR. Research assistants visited case-patients' homes within 30 days of hospital visit/discharge and administered a structured questionnaire to capture direct medical costs (physician consultation, hospital bed, medicines and diagnostic tests), direct non-medical costs (food, lodging and travel) and indirect costs (case-patients' and caregivers' lost income). We used WHO-Choice estimates for routine healthcare service costs. We added direct, indirect and healthcare service costs to calculate cost-per-episode. We used median cost-per-episode, published influenza-associated outpatient and hospitalization rates and Bangladesh census data to estimate the annual economic burden of influenza-associated illnesses in 2010.

RESULTS: We interviewed 132 outpatients and 41 hospitalized patients. The median cost of an influenza-associated outpatient visit was US$4.80 (IQR = 2.93-8.11) and an influenza-associated hospitalization was US$82.20 (IQR = 59.96-121.56). We estimated that influenza-associated outpatient visits resulted in US$108 million (95% CI: 76-147) in direct costs and US$59 million (95% CI: 37-91) in indirect costs; influenza-associated hospitalizations resulted in US$1.4 million (95% CI: 0.4-2.6) in direct costs and US$0.4 million (95% CI: 0.1-0.8) in indirect costs in 2010.

CONCLUSIONS: In Bangladesh, influenza-associated illnesses caused an estimated US$169 million in economic loss in 2010, largely driven by frequent but low-cost outpatient visits.

Original languageEnglish
JournalInfluenza and Other Respiratory Viruses
Issue number4
Pages (from-to)406-413
Number of pages8
Publication statusPublished - 2014


  • Adolescent
  • Adult
  • Ambulatory Care/economics
  • Bangladesh/epidemiology
  • Child
  • Child, Preschool
  • Female
  • Health Expenditures/statistics & numerical data
  • Hospitalization/economics
  • Humans
  • Infant
  • Infant, Newborn
  • Influenza, Human/economics
  • Male
  • Middle Aged
  • Orthomyxoviridae/isolation & purification
  • Reverse Transcriptase Polymerase Chain Reaction
  • Surveys and Questionnaires
  • Young Adult


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