Enteroviral meningitis - Cost of illness and considerations for the economic evaluation of potential therapies

With limited financial resources available, it is now becoming more accepta ble to evaluate medical innovations in terms of incremental economic value. The purpose of this paper is to provide an overview of enteroviral meningi tis and to summarise the economic literature to identify relevant costs and outcomes. Enteroviral meningitis is the most common cause of aseptic meningitis, and occurs in 4.5 to 30 per 100 000 population annually with a duration of illn ess lasting between I and 2 weeks after onset of initial symptoms. The majo r resource categories that contribute to the overall direct costs of manage ment of enteroviral meningitis include physician visits, hospital admission s, emergency room visits, medications, procedures such as lumbar puncture a nd computed tomography scans, re-hospitalisations and follow-up physician v isits. Indirect costs are incurred in terms of school or work days missed o r restrictions in daily activities. The total direct costs of an episode of enteroviral meningitis range from $US450 for outpatients to $US5093 for in patient management(1996 values). The total indirect costs of an episode of enteroviral meningitis are estimated to be equivalent to 5 to 7 activity-re stricted days. Interventions that improve early diagnosis or decrease the duration and nee d for hospitalisation will significantly affect the cost of managing entero viral meningitis. Additional prospective studies are needed to study the im pact of interventions on the burden of enteroviral meningitis.