128 - Medical Costs of Influenza-Related Emergency Department Visits and Hospitalizations by Children 0-17 Years of Age, New Vaccine Surveillance Network, 2016-2019

Publication Number: 128.5817

Christina S.. Albertin, University of Rochester School of Medicine and Dentistry, Indianapolis, IN, United States; Khadijah Bland, University of Rochester School of Medicine and Dentistry, Pomfret, MD, United States; Samantha M. Olson, CDC, Atlanta, GA, United States; Elaine L. Hill, University of Rochester, Rochester, NY, United States; Peter Szilagyi, UCLA, Los Angeles, California, CA, United States; Eileen Klein, Seattle Children's, Seattle, WA, United States; janet Englund, Seattle Children’s Hospital, Seattle, WA, United States; Natasha Halasa, Vanderbilt University Medica Center, Nashville, TN, United States; Laura Stewart, Vanderbilt University School of Medicine, nashville, TN, United States; Rangaraj A. Selvarangan, Childrens Mercy Kansas City, Kansas City, MO, United States; Christopher j. Harrison, University of Missouri-Kansas City School of Medicine, Bardstown, KY, United States; Julie A. Boom, Baylor College of Medicine, Houston, TX, United States; Leila C. Sahni, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, United States; Mary Allen Staat, CCHMC, Cincinnati, OH, United States; Elizabeth P. Schlaudecker, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Benjamin Clopper, US Centers for Disease Control and Prevention, Atlanta, GA, United States; Heidi Moline, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States; Geoffrey A. Weinberg, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States

Background: Influenza is an important seasonal respiratory virus in children that leads to many emergency department (ED) visits and hospitalizations annually. Despite its impact on ED visits and hospitalization, the current medical costs of influenza-related ED visits and hospitalization are largely unknown.

Objective: To provide contemporary direct medical cost estimates of ED visits and hospitalizations among children with laboratory-confirmed influenza enrolled in the New Vaccine Surveillance Network (NVSN).

Design/Methods: We identified children < 18 years with laboratory-confirmed (RT-PCR) influenza at six NVSN children’s hospitals through active ED and inpatient surveillance for acute respiratory infections. We conducted medical chart reviews and reviewed hospital accounting data to assess medical costs. Cases treated in the ED (without hospital admission) and those with a hospitalization were analyzed separately. The study period comprised the 2016-2019 influenza seasons. Costs were adjusted for inflation to 2022 dollars.

Results: Of 1863 influenza-positive children, 1215 were seen in the ED and 648 hospitalized (Table 1); 82% of those seen in the ED and 59% of those hospitalized had no underlying chronic conditions. For ED influenza-related visits, the mean visit cost was $2,277 and the median visit cost was $527 (Table 2). Room and board accounted for 74% of the total mean cost, while diagnostics (e.g. radiology, laboratory testing), professional fees, and therapeutics (e.g. pharmaceutics, other therapies) accounted for 13%, 8% and 5%, respectively. For hospitalizations, the mean cost was $12,926 and the median cost was $6,378 (Table 2). Room and board accounted for 61% of the total mean cost of the hospitalizations, while diagnostics, professional fees, and therapeutics accounted for 9%, 10%, and 20%, respectively. Factors associated with higher median hospitalization costs (Table 3) included age ≥6 months and ICU care. Having an underlying medical condition was not associated with a higher median hospitalization cost.

Conclusion(s): The financial burden of pediatric ED visits and hospitalizations for influenza is substantial. Children with no underlying medical condition represented the majority of the study population and had median hospitalization costs comparable to children with an underlying medical condition. These results reinforce the importance of influenza immunization of all children to reduce influenza-related morbidity and the high cost of treatment associated with it.

Table 1- Demographics of Influenza-positive children, 2016-2019, Emergency Department Visit or Hospitalization


Table 2: Medical Costs by Category for an Influenza-Related Pediatric Emergency Department Visit or Hospitalization


Table 3: Influenza Hospitalization Costs by Demographic and Medical Characteristics