BackgroundIn view of ongoing pandemic threats such as the recent human cases of novel avian influenza A(H7N9) in China, it is important that all countries continue their preparedness efforts. Since 2006, Central American countries have received donor funding and technical assistance from the U.S. Centers for Disease Control and Prevention (CDC) to build and improve their capacity for influenza surveillance and pandemic preparedness. Our objective was to measure changes in pandemic preparedness in this region, and explore factors associated with these changes, using evaluations conducted between 2008 and 2012.MethodsEight Central American countries scored their pandemic preparedness across 12 capabilities in 2008, 2010 and 2012, using a standardized tool developed by CDC. Scores were calculated by country and capability and compared between evaluation years using the Student’s t-test and Wilcoxon Rank Sum test, respectively. Virological data reported to WHO were used to assess changes in testing capacity between evaluation years. Linear regression was used to examine associations between scores, donor funding, technical assistance and WHO reporting.ResultsAll countries improved their pandemic preparedness between 2008 and 2012 and seven made statistically significant gains (p < 0.05). Increases in median scores were observed for all 12 capabilities over the same period and were statistically significant for eight of these (p < 0.05): country planning, communications, routine influenza surveillance, national respiratory disease surveillance, outbreak response, resources for containment, community interventions and health sector response. We found a positive association between preparedness scores and cumulative funding between 2006 and 2011 (R2 = 0.5, p < 0.01). The number of specimens reported to WHO from participating countries increased significantly from 5,551 (2008) to 18,172 (2012) (p < 0.01).ConclusionsCentral America has made significant improvements in influenza pandemic preparedness between 2008 and 2012. U.S. donor funding and technical assistance provided to the region is likely to have contributed to the improvements we observed, although information on other sources of funding and support was unavailable to study. Gains are also likely the result of countries’ response to the 2009 influenza pandemic. Further research is required to determine the degree to which pandemic improvements are sustainable.

Recibido el 12 de marzo de 2015; aceptado el 13 de abril de 2015 Disponible en Internet el 10 de junio de 2015 PALABRAS CLAVEInfección respiratoria aguda grave; Costos directos de atención; Nicaragua ResumenObjetivo: Estimar los costos de tratamiento hospitalario de la infección respiratoria aguda grave (IRAG) en niños en Nicaragua. Métodos: Se estimaron costos de tratamiento de pacientes hospitalizados a partir del microcosteo retrospectivo de una muestra aleatoria de casos ocurridos durante el periodo 2009-2011 en Nicaragua y atendidos en un hospital pediátrico universitario de alta complejidad. Se calculó una muestra aleatoria de pacientes con diagnósticos de IRAG (CIE-10), según parámetros extraídos de la literatura. En esta, se estimó el costo promedio por paciente. Los costos fueron expresados en moneda local de 2011 y dólares americanos. Resultados: El costo promedio total de atención de caso en niños fue de 314,9 US$ (intervalo de confianza [IC] 95%: 280,1-349,7 US$) y de 971,6 (655,5-1.287,8 US$) para los que requirieron UCI. El 41% de los costos en los que solo requieren hospitalización general se explican por gastos de hotelería, mientras que en los que requieren UCI el 52% es por medicamentos. Conclusión: El microcosteo de los casos incluidos de IRAG permitió estimar un valor medio por caso tratado, con sus respectivos IC y estos podrían tener validez para el total de la población atendida por estos diagnósticos en hospitales con similar perfil epidemiológico y similar nivel de complejidad en Nicaragua.

A253 the study period. Controls were selected based on a propensity score methodology ensuring exactly the same baseline lung disease distribution between the 2 groups and no medical claim for PH across the entire study period. RESULTS: A total of 2,236 cases met study criteria. On average, cases were significantly (p< 0.01) younger (67 vs. 71), more females (64% vs 58%) and higher comorbid burden (2.8 vs 2.09) compared to controls. After adjusting for all baseline characteristics cases had significantly higher (p< 0.001) inpatient admissions (5.0 vs 2.4), physician office visits (16.5 vs 12.5), emergency room visits (0.7 vs 0.5), pharmacy claims (67 vs 54). This translated into higher expenditures among cases ($42,914) vs controls ($16,745) at per patient per year level. CONCLUSIONS: Using health plan data this study showed that Group 3-PH poses a significant economic burden to payers. PHS36HoSPitalization coStS due to Severe acute reSPiratory infection (Sari) in tHree central american countrieS

Objective: To estimate the direct medical costs of severe acute respiratory infection (SARI) in children and adults from three Central American countries with a bottom-up costing approach.Methods: The costs of inpatients treatment were estimated through the retrospective bottom-up costing in a randomized sample of clinical records from SARI patients treated in teaching tertiary hospitals during 2009 - 2011 period. Activities incurred per patient were registered and a setting-specific cost per activity was acquired. Average cost per patient in the group of children and elderly adults was estimated for each country. In Nicaragua, only the pediatric population was included. Costs were expressed in local currency (2011), American dollars, and international dollars (2005) for country comparison.Results: The care cost per case in children in Guatemala was the cheaper (I$971.95) compared to Nicaragua (I$1,431.96) and Honduras (I$1,761.29). In adults, the treatment cost for Guatemala was the more expensive: I$4,065.00 vs. I$2,707.91 in Honduras.Conclusion: Bottom-up costing of SARI cases allowed the mean estimates per treated case that could have external validity for the target population diagnosed in hospitals with similar epidemiological profiles and level of complexity for the study countries. This information is very relevant for the decision-making.