Estimating the Hospital Burden of Norovirus-Associated Gastroenteritis in England and Its Opportunity Costs for Nonadmitted Patients

Clin Infect Dis. 2018 Aug 16;67(5):693-700. doi: 10.1093/cid/ciy167.


Background: Norovirus places a substantial burden on healthcare systems, arising from infected patients, disease outbreaks, beds kept unoccupied for infection control, and staff absences due to infection. In settings with high rates of bed occupancy, opportunity costs arise from patients who cannot be admitted due to beds being unavailable. With several treatments and vaccines against norovirus in development, quantifying the expected economic burden is timely.

Methods: The number of inpatients with norovirus-associated gastroenteritis in England was modeled using infectious and noninfectious gastrointestinal Hospital Episode Statistics codes and laboratory reports of gastrointestinal pathogens collected at Public Health England. The excess length of stay from norovirus was estimated with a multistate model and local outbreak data. Unoccupied bed-days and staff absences were estimated from national outbreak surveillance. The burden was valued conventionally using accounting expenditures and wages, which we contrasted to the opportunity costs from forgone patients using a novel methodology.

Results: Between July 2013 and June 2016, 17.7% (95% confidence interval [CI], 15.6%‒21.6%) of primary and 23.8% (95% CI, 20.6%‒29.9%) of secondary gastrointestinal diagnoses were norovirus attributable. Annually, the estimated median 290000 (interquartile range, 282000‒297000) occupied and unoccupied bed-days used for norovirus displaced 57800 patients. Conventional costs for the National Health Service reached £107.6 million; the economic burden approximated to £297.7 million and a loss of 6300 quality-adjusted life-years annually.

Conclusions: In England, norovirus is now the second-largest contributor of the gastrointestinal hospital burden. With the projected impact being greater than previously estimated, improved capture of relevant opportunity costs seems imperative for diseases such as norovirus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism
  • Adult
  • Aged
  • Aged, 80 and over
  • Caliciviridae Infections / economics*
  • Caliciviridae Infections / epidemiology
  • Cost of Illness
  • Cross Infection / economics
  • Cross Infection / epidemiology
  • Cross Infection / virology
  • Disease Outbreaks / economics*
  • Disease Outbreaks / prevention & control
  • England / epidemiology
  • Female
  • Gastroenteritis / economics*
  • Gastroenteritis / epidemiology
  • Gastroenteritis / virology
  • Hospitalization / economics*
  • Humans
  • Infection Control / economics*
  • Inpatients
  • Male
  • Middle Aged
  • Norovirus / isolation & purification