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Costs associated with outpatient diarrhoea in infants and toddlers: a nationwide study of the Italian Society of Paediatric Gastroenterology and Hepatology (SIGEP)

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Abstract

Background. As diarrhoea mortality is negligible in Italy, other costs should be considered when planning health strategies. Little is known about the costs associated with diarrhoea in Italian children.

Aims. To assess the costs associated with outpatient infantile diarrhoea in Italy.

Methods. Primary care paediatricians from five regions filled in a questionnaire for the first 10 children (1–47 months) they visited for acute diarrhoea during a 3-month period.

Results. We analysed 473 questionnaires. Mean age (standard deviation) of children was 21 (11) months; mean duration of diarrhoea (standard deviation) was 4.3 (2.6) days. An overall cost of 110 (137) euro per episode was estimated, with significant difference between children younger and older than 36 months (116 euro versus 72 euro). Missed work by relatives accounts for 75% of the cost. The parents of children attending a day-care centre had an increased risk to miss work (relative risk = 2.15). A weak relationship was found between days of diarrhoea and missed work (r=0.30); it could be estimated that the diarrhoea should be shortened by about 4 days in order to save 1 day of missed work.

Conclusions. Acute outpatient diarrhoea is associated with a significant financial burden in Italy. Simply shortening the diarrhoea does not seem to be the most expeditious way to reduce the cost of diarrhoea itself.

Introduction

Diarrhoeal diseases continue to be a major cause of mortality and morbidity worldwide [1].

In developed countries morbidity remains very high even if death has become rare. In the United States one to two diarrhoeal episodes per child per year in children less 5 years of age are estimated, accounting for 21–37 million of episodes of diarrhoea each year [2]. In a recall study performed in Finland the seasonal adjusted annual diarrhoea incidence in children younger then 5 years was 0.48 episodes per child per year [3]. In Italy, a multicentre recall study found an incidence of 0.97 episodes per child per year in children aged less than 3 years [4].

Costs of acute diarrhoea, even when treated as outpatients, could be high. In 1998 in the United States acute diarrhoea in children less than 5 years led to 2–3.7 million doctor visits with an estimated average cost ranging from $47 to $57 [5]. In 1991, a cohort study of children attending day-care centres estimated a cost of $87 per episode of diarrhoea; in this study costs related only to the care of the ill child (74%; mainly the value of the workdays missed by parents), to hospitalisation (19%) and to doctor visits (7%) were included [6]. More recently, an average cost of $289 per episode was estimated when factors as missed work, laboratory tests, medications, special foods, travel expenses, extra diapers, etc. were included [7].

Reliable estimates of the factors associated with costs contribute to implement the best cost-effective strategies for infantile diarrhoea in developed countries. To the best of our knowledge there are no data about costs of outpatients diarrhoea in Italy.

The aim of this multicentre study was to gather a nationwide estimate of the costs, and of the contributing factors, associated with outpatient diarrhoea in children younger than 4 years in Italy.

Section snippets

Patients and methods

Five local coordinators (MF, PP, FF, AL, RBC) in five different Italian regions asked the family paediatricians with the office in their district to fill in a structured questionnaire for the first 10 children with acute-onset diarrhoea and aged 1–47 months, they treated as outpatients between February and April 2001. Acute diarrhoea was defined as three or more loose or watery stools per day. Table 1 lists the main items of the questionnaire.

Informed consent was obtained by each paediatrician

Results

Fifty-one paediatricians participated in the study and returned 495 questionnaires. Nineteen questionnaires were excluded because they lacked some data (mainly the date of birth or of end of diarrhoea), and three were discharged because the age of child was above 47 months. Therefore, 473 questionnaires remained for analysis.

Main characteristics of the enrolled children are shown in Table 2. The duration of diarrhoea (mean and S.D.) was 4.3 (2.6) days. Eleven children (2.3%) had diarrhoea for

Discussion

In this multicentre study we estimated an overall cost of about 110 euro for a diarrhoea episode in children aged less than 4 years treated as outpatients. Seventy-five percent of this cost resulted from missed work by the child’s parents. To our best knowledge no similar studies have yet been published from Italy or even from Europe.

The most reliable comparison could be done with the study conducted by Avendaño et al. [7] in 1993 in Texas, United States, in which an average cost of $289 per

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