The true cost of epidemic and outbreak diseases in hospitals

Background: Outbreaks of infectious diseases may result in bed pressures, which are often mitigated by delaying new admissions due to beds being unavailable. This painfully illustrates to policy makers and the public what is meant by the economic notion of “opportunity costs”: The value of the next-best alternative forgone, or in this situation: The value of the beds for the displaced patients. These opportunity costs need to be captured adequately in economic analyses. Methods: Suitable approaches for estimating the opportunity costs of healthcare beds from the perspective of health-maximising decision makers were searched for in a literature review. Lack of adequate methods drove the development of a novel approach. Differences among approaches were explored using, as a case study, hospitalisations for norovirus-associated gastroenteritis. Its hospital burden was quantified nationally for England using statistical modelling. Afterwards, a stochastic mathematical model of hospital wards was built to explore the additional bed pressures on occupancy levels due to transmission-dynamic norovirus outbreaks. Results: Health-maximising decision makers should approximate the opportunity costs of healthcare beds by considering the net benefit of the second-best admissions forgone. This novel approach estimated a loss of 6,300 quality-adjusted life years (QALYs) annually in England and economic costs of £190−£298 million due to norovirus, roughly 2−3 times higher than the financial expenditures incurred of £108 million. During norovirus outbreaks, additional bed pressures arise 83.0% of the time, preventing a mean of 6.8 (range 0−44) new admissions that could have been admitted had there been no outbreak. Conclusions: Owing to market imperfections, the true value of healthcare beds differs from the value calculated using pragmatic conventions. In this thesis, these opportunity costs were estimated for the first time by explicitly including the wider health impact for other patients awaiting admission. The higher values obtained may impact the outcome of economic analyses.