Health and economic burden of influenza-associated illness in South Africa, 2013-2015

Influenza Other Respir Viruses. 2019 Sep;13(5):484-495. doi: 10.1111/irv.12650. Epub 2019 Jun 11.


Background: Economic burden estimates are essential to guide policy-making for influenza vaccination, especially in resource-limited settings.

Methods: We estimated the cost, absenteeism, and years of life lost (YLL) of medically and non-medically attended influenza-associated mild and severe respiratory, circulatory and non-respiratory/non-circulatory illness in South Africa during 2013-2015 using a modified version of the World Health Organization (WHO) worksheet based tool for estimating the economic burden of seasonal influenza. Additionally, we restricted the analysis to influenza-associated severe acute respiratory illness (SARI) and influenza-like illness (ILI; subsets of all-respiratory illnesses) as suggested in the WHO manual.

Results: The estimated mean annual cost of influenza-associated illness was $270.5 million, of which $111.3 million (41%) were government-incurred costs, 40.7 million (15%) were out-of-pocket expenses, and $118.4 million (44%) were indirect costs. The cost of influenza-associated medically attended mild illness ($107.9 million) was 2.3 times higher than that of severe illness ($47.1 million). Influenza-associated respiratory illness costs ($251.4 million) accounted for 93% of the total cost. Estimated absenteeism and YLL were 13.2 million days and 304 867 years, respectively. Among patients with influenza-associated WHO-defined ILI or SARI, the costs ($95.3 million), absenteeism (4.5 million days), and YLL (65 697) were 35%, 34%, and 21% of the total economic and health burden of influenza.

Conclusion: The economic burden of influenza-associated illness was substantial from both a government and a societal perspective. Models that limit estimates to those obtained from patients with WHO-defined ILI or SARI substantially underestimated the total economic and health burden of influenza-associated illness.

Keywords: South Africa; economic burden; influenza; years of life lost.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Absenteeism*
  • Cost of Illness*
  • Hospitalization / economics*
  • Hospitalization / statistics & numerical data
  • Humans
  • Influenza Vaccines / administration & dosage
  • Influenza, Human / complications
  • Influenza, Human / economics*
  • Influenza, Human / epidemiology
  • Life Expectancy*
  • Seasons
  • Sentinel Surveillance
  • South Africa / epidemiology
  • Vaccination / legislation & jurisprudence


  • Influenza Vaccines