Economic burden of varicella in children 1–12 years of age in Argentina, 2009–2014

Figures & data

Table 1. Key unit costs (2015 USD)^† for healthcare resources.

	Mean cost
Healthcare resource
Visits to doctor’s office^33–36	USD	24.1
Visits to ER^41	USD	16.6
Visits to hospital outpatient clinic^44	USD	50.9
Day of hospitalization^33^,^35^,^36^,^41^,^43^,^44	USD	399.7
Day of ICU stay^41^,^45	USD	315.5
Allied healthcare professional consult
Physiotherapist^38	USD	18
Social Worker^39	USD	31
Specialist Physician^37	USD	30

Abbreviations. ARS, Argentine Peso; ER, emergency room; ICU, intensive care unit; USD, United States dollar.

† Exchange rate (2015): 1 ARS = 0.11 USD⁵¹.

Per unit costs for prescription medications^31,32 OTC medications^31,32, and tests/procedures^{34–36,39–41} were calculated individually by specific type and summed.

Figure 1. Types of complications associated with varicella. *Proportions based on the total number of patients. †Proportions based on the total number of complications. ‡Inpatients: Other includes encephalitis (3.1%), keratoconjunctivitis (2.1%), dehydration (2.1%), hemorrhagic varicella (2.1%), arthritis (1.0%), gingivostomatitis (1.0%), myositis (1.0%), pancytopenia (1.0%), preseptal cellulitis left eye (1.0%), septic arthritis (1.0%), scarlatiniform rash (1.0%).

Table 2. Patient and disease characteristics at varicella diagnosis.

	Outpatients (n = 75)	Inpatients (n = 75)
Patient characteristics
Age, years, mean (SD)	3.8 (2.4)	2.9 (2.2)
Gender, n (%)
Male	40 (53.3%)	46 (61.3%)
Female	35 (46.7%)	29 (38.7%)
Area of residence, n (%)
Urban	70 (93.3%)	62 (82.7%)
Rural	4 (5.3%)	12 (16.0%)
Missing	1 (1.3%)	1 (1.3%)
Body Mass Index (BMI), kg/m^2, mean (SD)	17.6 (2.9)	16.5 (2.7)
Calendar year of diagnosis, n (%)
2009	3 (4.0%)	2 (2.7%)
2010	11 (14.7%)	1 (1.3%)
2011	7 (9.3%)	11 (14.7%)
2012	8 (10.7%)	20 (26.7%)
2013	46 (61.3%)	31 (41.3%)
2014	0 (0.0%)	10 (13.3%)
Disease characteristics
Maximum number of skin lesions during rash, n (%)
<50	20 (26.7%)	3 (4.0%)
50–249	36 (48.0%)	50 (66.7%)
250–500	17 (22.7%)	14 (18.7%)
>500	2 (2.7%)	8 (10.7%)
Patients with at least one complication, n (%)	21 (28.0%)	74 (98.7%)
Number of complications, n (% of complications)
1 complication	20 (95.2%)	57 (77.0%)
≥2 complications	1 (4.8%)	17 (23.0%)
Patients who were immunocompromised^†, n (%)	1 (1.3%)	1 (1.3%)

SD, standard deviation.

† Patients were considered immunocompromised if they had at least one of the following conditions: HIV/AIDS, congenital immunodeficiency, received system steroids, or had any other immunocompromised condition listed in their medical history.

Table 3. Varicella associated healthcare resource utilization.

Type of HCRU	Outpatients (n = 75)		Inpatients (n = 75)
	% Patients	Mean (95% CI)^†	% Patients	Mean (95% CI)^†
Visits to doctor’s office^‡	12.0%	2.2 (1.4–3.3)	4.0%	3.0 (1.4–5.4)
Visits to ER^‡	10.7%	1.1 (0.5–2.0)	26.7%	1.1 (0.7–1.6)
Visits to hospital outpatient clinic^‡	86.7%	2.1 (1.8–2.5)	17.3%	1.5 (0.9–2.2)
Total outpatient visits^£	100%	2.2 (2.1–2.4)	33.3%	1.1 (1.0–1.2)
Hospitalization	N/A	N/A	100%	4.9 (4.2–5.7)
ICU stay	N/A	N/A	8.0%	4.8 (1.6–14.1)
Prescription medications*	26.7%	1.8 (1.3–2.5)	77.3%	2.3 (2.0–2.7)
OTC medications^§	58.7%	1.4 (1.1–1.8)	94.7%	2.6 (2.3–3.0)
Tests/procedures^¶	13.3%	2.4 (1.6–3.5)	70.7%	6.8 (6.1–7.5)
Allied health professional consultations^|	1.3%	1.0 (N/C)	32.0%	5.4 (4.5–6.4)

Abbreviations. CI, confidence interval; ER, emergency room; HCRU, healthcare resource utilization; ICU, intensive care unit; N/A, not applicable; N/C, not calculable; OTC, over the counter.

* Includes prescriptions for antibiotics, antivirals, and immunoglobulins.

† Average number of times each healthcare resource was used among users; for hospitalization and hospital ICU stay, it denotes the duration of days; for sick leave it denotes the duration of days between the doctor’s note to stay home and return to school.

‡ Patients may have reported more than one type of outpatient healthcare contact.

¶ Includes imaging modalities, cultures, and confirmatory VZV assessments.

§ Includes use of acetaminophen, ibuprofen, “other” anti-inflammatory drugs, topical anti-itch cream, oral anti-histamines, and “other” OTC medication.

| Includes visits to a physiotherapist, social worker, or specialist physician.

£ Mean sum of visits to doctor’s office, ER, and hospital outpatient clinic.

Table 4. Cost (USD) per pediatric case of varicella.

	Outpatients (n = 75)			Inpatients (n = 75)
	Mean	cost^†	95% CI	Mean	cost^†	95% CI
Direct costs
Visits to doctor’s office	USD	6.4	(2.3–10.6)	USD	2.9	(0.0–6.7)
Visits to ER	USD	2.0	(0.6–3.4)	USD	4.7	(2.8, 6.5)
Visits to hospital outpatient clinic	USD	93.0	(82.4–103.6)	USD	12.9	(5.4–20.4)
Hospitalization	USD	0.0	(N/C)	USD	2,464.6	(1,949.7–2,979.5)
ICU stay	USD	0.0	(N/C)	USD	138.8	(0.0–299.0)
Prescription medications*	USD	6.9	(2.7–11.0)	USD	71.5	(18.1–124.9)
OTC medications^§	USD	3.6	(1.5–5.7)	USD	6.1	(4.3–7.9)
Tests/procedures^¶	USD	3.4	(1.2–5.6)	USD	59.6	(39.4–79.9)
Allied health professional consultations^|	USD	0.4	(0.0–1.2)	USD	43.5	(9.4–77.7)
Overall direct costs	USD	115.7	(105.7–125.7)	USD	2,804.6	(2,085.0–3,524.1)
Indirect costs
Lost work by caregivers^£	USD	207.0	(179.8–234.2)	USD	143.2	(113.6–172.8)
Total	USD	322.7	(292.4–353.1)	USD	2,947.7	(2,199.4–3,696.1)

Abbreviations. CI, confidence interval; ER, emergency room; ICU, intensive care unit; N/A, not applicable; N/C, not calculable; OTC, over the counter; USD, United States dollar.

* Includes costs of prescriptions for antibiotics, antivirals, and immunoglobulins.

† Mean (95% CI) among all patients. Based on patients with available information.

¶ Includes costs of imaging modalities, cultures, and confirmatory VZV assessments.

§ Includes costs of acetaminophen, ibuprofen, “other” anti-inflammatory drugs, topical anti-itch cream, oral anti-histamines, and “other” OTC medication.

| Includes costs of visits to a physiotherapist, social worker, or specialist physician.

£ For inpatients: based on the mean [95% CI] number of days spent in the hospital (4.9 [4.2–5.7]) and/or ICU (4.8 [1.6–14.1]); for outpatients: based on the mean [95% CI] number of days elapsed between the issuance of a sick note by a doctor, and the return to school (7.8 [6.9–8.8] days).

Table 5. Estimated annual (2015) costs (USD) for children with varicella in Argentina.^†

	Annual cost (USD)	% of Total direct cost
Direct costs
Visits to doctor’s office	788,370.3	5.4%
Visits to ER	244,343.5	1.7%
Visits to outpatient clinic	11,376,757.0	77.4%
Hospitalization	480,597.0	3.3%
ICU stay	27,069.9	0.2%
Prescription medications*	853,128.3	5.8%
OTC medications^§	445,239.6	3.0%
Tests/procedures^¶	426,324.6	2.9%
Allied health professional consultations^|	57,420.4	0.4%
Total direct costs	14,699,250.8	N/A
Indirect costs
Lost work by caregivers	25,355,127.2	N/A
Total	40,054,378.0	N/A

Abbreviations. ER, emergency room; ICU, intensive care unit; N/A, not applicable; OTC, over the counter; USD, United States dollar.

* Includes costs of prescriptions for antibiotics, antivirals, and immunoglobulins.

¶ Includes costs of imaging modalities, cultures, and confirmatory VZV assessments.

§ Includes costs of acetaminophen, ibuprofen, “other” anti-inflammatory drugs, topical anti-itch cream, oral anti-histamines, and “other” OTC medication.

| Includes costs of visits to a physiotherapist, social worker, or specialist physician.

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