COST OF AN OUTBREAK OF HEPATITIS-A IN PUGLIA, ITALY

In total, 5889 cases of hepatitis A virus infection were reported duri ng an outbreak in Puglia, a region of Southern Italy, in 1996. The pri mary cause of the outbreak was consumption of contaminated food (raw s hellfish, vegetables, etc.), with a contributory risk factor of person -to-person transmission. A detailed questionnaire was completed by 250 randomly selected patients to obtain information sufficient to calcul ate the direct and indirect costs of the outbreak for the individual p atient, the National Health Service (NHS) and society as a whole. A co nversion rate of $US1 = 1530 Italian lire (L) has been used throughout the study since this was the average exchange rate in 1996. For the i ndividual patient with hepatitis A virus infection, the mean cost was L1.013 million (SUS662), which was equivalent to 6.6% of the mean annu al income of the employed patients. The total cost of the outbreak to the NHS was L23.98 billion ($US15.67 million), which was equivalent to 0.4% of the total public health expenditure in the region in 1996. Th e total cost of the outbreak to society (individual patient, NHS and t hird parties combined) was L37.406 billion ($US24.45 million), corresp onding to 0.04% of the gross domestic product of the entire region in 1996, with a mean cost per patient of L6.35 million ($US4150) from a s ocietal perspective. The majority of patients (86.3%) were 11 to 30 ye ars of age, reflecting the increasing susceptibility of younger patien ts to hepatitis A virus infection in recent decades. These economic an d demographic data provide important information for the evaluation of preventive strategies including public education, sanitation and immu nisation, so as to optimise the use of local health resources.