Health burden and economic impact of measles-related hospitalizations in Italy in 2002–2003

BACKGROUND A large measles outbreak occurred in Italy in 2002-2003. This study evaluates the health burden and economic impact of measles-related hospitalizations in Italy during the specified period. METHODS Hospital discharge abstract data for measles hospitalizations in Italy during 2002-2003 were analysed to obtain information regarding number and rates of measles hospitalizations by geographical area and age group, length of hospital stay, and complications. Hospitalization costs were estimated on the basis of Diagnosis-Related Groups. RESULTS A total of 5,154 hospitalizations were identified, 3,478 (67%) of which occurred in children <15 years of age. Most hospitalizations occurred in southern Italy (71 %) and children below 1 year of age presented the greatest hospitalization rates (46.2/100,000 and 19.0/100,000, respectively in 2002 and 2003). Pneumonia was diagnosed in 594 cases (11.5%) and encephalitis in 138 cases (2.7%). Total hospital charges were approximately euro 8.8 million. CONCLUSION The nationwide health burden associated with measles during the 2002-2003 outbreak was substantial and a high cost was incurred by the Italian National Health Service for the thousands of measles-related hospitalizations which occurred. By assuming that hospital costs represent 40-50% of the direct costs of measles cases, direct costs of measles for the two years combined were estimated to be between 17.6-22.0 million euros, which equates to the vaccination of 1.5-1.9 million children (3-4 birth cohorts) with one dose of MMR. The high cost of measles and the severity of its complications fully justify the commitment required to reach measles elimination.