The cost of lower respiratory tract infections hospital admissions in the Canadian Arctic

Abstract

BackgroundInuit infants who reside in the Nunavut (NU) regions of Arctic Canada have extremely high rates of lower respiratory tract infections (LRTIs) associated with significant health expenditures, but the costs in other regions of Arctic Canada have not been documented.ObjectiveThis prospective surveillance compares, across most of Arctic Canada, the rates and costs associated with LRTI admissions in infants less than 1 year of age, and the days of hospitalization and costs adjusted per live birth.DesignThis was a hospital-based surveillance of LRTI admissions of infants less than 1 year of age, residing in Northwest Territories (NT), the 3 regions of Nunavut (NU); [Kitikmeot (KT), Kivalliq (KQ) and Qikiqtani (QI)] and Nunavik (NK) from 1 January 2009 to 30 June 2010. Costs were obtained from the territorial or regional governments and hospitals, and included transportation, hospital stay, physician fees and accommodation costs. The rates of LRTI hospitalizations, days of hospitalization and associated costs were calculated per live birth in each of the 5 regions.ResultsThere were 513 LRTI admissions during the study period. For NT, KT, KQ, QI and NK, the rates of LRTI hospitalization per 1000 live births were 38, 389, 230, 202 and 445, respectively. The total days of LRTI admission per live birth were 0.25, 3.3, 2.6, 1.7 and 3 for the above regions. The average cost per live birth for LRTI admission for these regions was $1,412, $22,375, $14,608, $8,254 and $10,333. The total cost for LRTI was $1,498,232 in NT, $15,662,968 in NU and $3,874,881 in NK. Medical transportation contributed to a significant proportion of the costs.ConclusionLRTI admission rates in NU and Nunavik are much higher than that in NT and remain among the highest rates globally. The costs of these admissions are exceptionally high due to the combination of very high rates of admission, very expensive medical evacuations and prolonged hospitalizations. Decreasing the rates of LRTI in this population could result in substantial health savings.

Cost-effectiveness of palivizumab compared to no prophylaxis in term infants residing in the Canadian Arctic

“…We extracted data from a 2009 prospective surveillance study of hospital admission for lower respiratory tract infection among infants less than 6 months of age residing in the Canadian Arctic. 10,15 We selected 8 Arctic regions for the study: the Northwest Territories, Nunavut, Nunavut without Iqaluit, the 3 subregions of Nunavut (Kitikmeot, Kivalliq and Qikiqtaaluk), the Qikiqtaaluk Region without Iqaluit, and Nunavik (northern Quebec). Data were collected prospectively except for the Qikiqtaaluk Region, where data were collected retrospectively.…”

“…10 We calculated the costs related to admission due to respiratory syncytial virus for each infant in each region ( Table 2). The main drivers for costs were related to transportation and admission, which were either actual or minimal estimates of costs (Table 1).…”

“…10 As the effectiveness of palivizumab could be a major driver in the model, we conducted sensitivity analyses recalculating ICERs using 88% risk reduction in scenario C.…”

“…The maximum number of doses was 6 in both scenarios. 10 The 2 scenarios were analyzed in each of the 8 Arctic regions. In addition, the cost-effectiveness of scenario A was directly compared with that of scenario B.…”

“…High rates of respiratory syncytial virus infection combined with expensive medical evacuations make hospital admissions for these infections the greatest health expenditure for infants in Nunavut. 7,9,10 Palivizumab, a monoclonal antibody against respiratory syncytial virus, was licensed in Canada in 2002. By 2005, government-funded palivizumab programs had been implemented across the Canadian Arctic.…”