Economic impact of a hepatitis A epidemic in a mid-sized urban community: the case of Spokane, Washington.

Data reported here represent an effort to build on previous work regarding the costs of hepatitis A. We expand this work to include an estimation of the costs of hepatitis A on a community wide basis. In addition to calculating the costs of disease management and health care delivery, we include an analysis of additional child care costs, lost productivity, costs associated with outbreak management, and the impact on affected restaurants that required public notification and the administration of Immune Globulin to patrons. The work reported here is specific to Spokane county, Washington. The objective is to enable the Spokane Regional Health District to communicate to the community costs of managing an outbreak of hepatitis A and to inform implementation of a hepatitis A vaccination program on a community wide basis. The average cost (direct and indirect) per case for the entire sample is 2,683 dollars. The estimated total cost for the sample (145 cases) is approximately 370,193 dollars. Inpatient hospital care is the largest direct medical expense and lost productivity is a major indirect cost to the community. Lessons learned from undertaking this task include: (1) costs incurred are not immediately obvious, (2) without infrastructure in place, tracking costs is difficult, if not impossible, (3) potential for large expenditures is apparent, (4) estimates are consistent with those generated in previous studies, and (5) previous findings of vaccination of certain high-risk populations as a cost-efficient approach is corroborated.