Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. e1321-e1327 (doi:10.1542/10.1542/peds.2006-0598)
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ARTICLE

Direct Medical Cost of Influenza-Related Hospitalizations in Children

Ron Keren, MD, MPHa, Theoklis E. Zaoutis, MD, MSCEb, Stephanie Saddlemire, MSPHa, Xian Qun Luan, MSc and Susan E. Coffin, MD, MPHb

a General Pediatrics
b Infectious Diseases
c Biostatistics and Epidemiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

OBJECTIVE. Our goal was to determine the cost of influenza-related hospitalization in children with community-acquired laboratory-confirmed influenza and to identify predictors of high hospitalization costs.

PATIENTS AND METHODS. This was a retrospective cohort study of patients 21 years and younger hospitalized at a children's hospital with community-acquired laboratory-confirmed influenza during 4 consecutive influenza seasons (2000–2004). The main outcome measure was the direct medical cost of influenza-related hospitalizations, including the cost of diagnostics, therapeutics, room, and physician services.

RESULTS. Electronic billing data were retrievable for 727 (98%) of 745 patients hospitalized for community-acquired laboratory-confirmed influenza during the study period. A total of 478 (66%) children were in a high-risk group for whom the Advisory Committee on Immunization Practices recommended influenza vaccine (patients with Advisory Committee on Immunization Practices–designated chronic medical conditions or aged 6–23 months). The mean total cost of hospitalization for influenza-related illness was $13159 ($39792 for patients admitted to an ICU; $7030 for patients cared for exclusively on the wards). High-risk patients had higher mean total costs ($15269) than low-risk patients ($9107). Cardiac, metabolic, and neurologic/neuromuscular diseases and age of 18 to 21 years were independently associated with the highest hospitalization costs (>15th percentile).

CONCLUSIONS. The cost of influenza-related hospitalizations in children may be considerably higher than previously estimated. The presence of certain Advisory Committee on Immunization Practices–designated chronic medical conditions is associated with higher influenza-related hospitalization costs. Successfully immunizing patients with these conditions has the potential for significant cost savings.

Key Words: influenza • vaccines • cost analysis • hospitalization • children

Abbreviations: ICD-9—International Classification of Diseases, Ninth Revision • CA-LCI—community-acquired laboratory-confirmed influenza • CHOP—Children's Hospital of Philadelphia • RSV—respiratory syncytial virus • ACIP—Advisory Committee on Immunization Practices • OR—odds ratio • IQR—interquartile range

Accepted May 24, 2006.


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