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. 2022 Dec 17;22(1):2369.
doi: 10.1186/s12889-022-14732-2.

Clinical and economic burden of physician-diagnosed influenza in adults during the 2017/2018 epidemic season in Spain

Ángel Gil-de-Miguel  1 , Federico Martinón-Torres  2   3   4 , Javier Díez-Domingo  5 , Raúl Ortiz de Lejarazu Leonardo  6 , Tomàs Pumarola  7 , Mafalda Carmo  8 , Georgina Drago  9 , Juan Luis López-Belmonte  9 , Hélène Bricout  10 , Caroline de Courville  10 , Esther Redondo Margüello  11
Affiliations

Clinical and economic burden of physician-diagnosed influenza in adults during the 2017/2018 epidemic season in Spain

Ángel Gil-de-Miguel et al. BMC Public Health. .

Abstract

Background: Influenza is an acutely debilitating respiratory infection, contributing significantly to outpatient visits and hospitalizations. Spain lacks comprehensive and updated data on the burden of influenza, particularly in the outpatient setting. Our study aimed to fill this gap by estimating the clinical and economic burden of physician-diagnosed influenza cases in adults from four Spanish regions, stratified by age groups and presence of comorbidities.

Methods: A retrospective cost-of-illness study was conducted using data from an electronic medical records database from the National Healthcare Service (NHS) of four Spanish regions for individuals aged ≥ 18 years diagnosed for influenza during the 2017/2018 epidemic season. Health resource utilization and related cost data were collected, including primary care visits, referrals to other specialists, visits to the emergency department, hospitalizations, and prescribed medicines.

Results: The study reported a total of 28,381 patients aged ≥ 18 years diagnosed with influenza, corresponding to 1,804 cases per 100,000 population. Most patients were aged < 65 years: 60.5% (n = 17,166) aged 18-49 and 26.3% (n = 7,451) 50-64 years. A total of 39.2% (n = 11,132) of patients presented a comorbidity. Cardiovascular diseases were the most common comorbidity reported along with influenza. The mean healthcare cost per case was estimated at €235.1 in population aged 18-49 years, increasing by 1.7 and 4.9 times in those aged 50-64 (€402.0) and ≥ 65 (€1,149.0), respectively. The mean healthcare cost per case was 3.2 times higher in patients with comorbidities. The total healthcare cost of medically attended influenza cases was mainly driven by primary care (45.1%) and hospitalization (42.0%). Patients aged 18-64 years old accounted for 61.9% of the costs of medically attended influenza. Irrespective of age, patients with comorbidities accounted for 67.1% of costs.

Conclusions: Season 2017/2018 was associated with a considerable burden of influenza in Spain, which increased with age and presence of comorbidities. Individuals with comorbidities accounted for most of the costs of influenza. Results suggest that population aged 18-64 years old is generating the highest share of costs to the NHS when all healthcare costs are considered. Preventive strategies targeting subjects with comorbidities, regardless of age, should be warranted.

Keywords: Burden; Cost analysis; Epidemiology; Health resources; Hospitalization; Influenza; Medical emergency service; Outpatients; Primary health care; Spain.

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Conflict of interest statement

Drago G, López-Belmonte JL, de Courville C and Bricout H are Sanofi employees and may hold shares and/or stock options in the company. Carmo M is an IQVIA employee. Gil-de-Miguel A and Díez-Domingo J have received fees from Sanofi. Martinón Torres F received honoraria from GSK group of companies, Pfizer Inc, Sanofi, MSD, Seqirus, and Janssen for taking part in advisory boards and expert meetings and for acting as a speaker in congresses outside the scope of the submitted work. Martinón Torres F has also acted as principal investigator in randomized controlled trials of the above-mentioned companies as well as Ablynx, Gilead, Regeneron, Roche, Abbott, Novavax, and MedImmune, with honoraria paid to his institution. Martinón Torres F receives support for research activities from the Instituto de Salud Carlos III (Proyecto de Investigación en Salud, Acción Estratégica en Salud): Fondo de Investigación Sanitaria (FIS; PI070069 / PI1000540 / PI1601569 / PI1901090) del plan nacional de I + D + I and FEDER and Proyectos GaIN Rescata-Covid_IN845D 2020/23 (GAIN, Xunta de Galicia). Ortiz de Lejarazu R received honoraria from AstraZeneca, GSK, MSD, Roche, Sanofi and Seqirus for taking part in advisory boards and expert meetings and for acting as a speaker in congresses outside the scope of the submitted work. Ortiz de Lejarazu R has been until 2019 Director of the National Influenza Centre, Valladolid, Spain without any salary for that position and has participate in regular commitments of Influenza and other respiratory virus surveillance. Pumarola T Received honoraria from Roche, Sanofi, Seegene and Seqirus for taking part in advisory boards and expert meetings and for acting as a speaker in congresses outside the scope of the submitted work. Redondo Margüello E received honoraria from GSK group of companies, Pfizer Inc, Sanofi, and MSD, for taking part in advisory boards and expert meetings and for acting as a speaker in congresses outside the scope of the submitted work.

Figures

Fig. 1
Fig. 1
Percentage of patients diagnosed for influenza with a relevant comorbidity by age group, 2017/2018 season
Fig. 2
Fig. 2
Mean healthcare cost per influenza case, by age groups, 2017/2018 season. a In patients aged 18–49 years old. b In patients aged 50–64 years old. c In patients aged ≥ 65 years old
Fig. 3
Fig. 3
Total healthcare cost of influenza cases stratified by age groups and presence of comorbidities, 2017/2018 season
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