The Clinical and Economic Burden of Norovirus Gastroenteritis in the United States

Abstract

Background: Although norovirus outbreaks periodically make headlines, it is unclear how much attention norovirus may receive otherwise. A better understanding of the burden could help determine how to prioritize norovirus prevention and control.

Methods: We developed a computational simulation model to quantify the clinical and economic burden of norovirus in the United States.

Results: A symptomatic case generated $48 in direct medical costs, $416 in productivity losses ($464 total). The median yearly cost of outbreaks was $7.6 million (range across years, $7.5-$8.2 million) in direct medical costs, and $165.3 million ($161.1-$176.4 million) in productivity losses ($173.5 million total). Sporadic illnesses in the community (incidence, 10-150/1000 population) resulted in 14 118-211 705 hospitalizations, 8.2-122.9 million missed school/work days, $0.2-$2.3 billion in direct medical costs, and $1.4-$20.7 billion in productivity losses ($1.5-$23.1 billion total). The total cost was $10.6 billion based on the current incidence estimate (68.9/1000).

Conclusion: Our study quantified norovirus' burden. Of the total burden, sporadic cases constituted >90% (thus, annual burden may vary depending on incidence) and productivity losses represented 89%. More than half the economic burden is in adults ≥45, more than half occurs in winter months, and >90% of outbreak costs are due to person-to-person transmission, offering insights into where and when prevention/control efforts may yield returns.

Keywords: burden; community; cost; norovirus; outbreaks.

Figure 1.

Cost per norovirus illness by age group showing baseline probabilities for mortality and missing school and work (A), impact of varying the probability of missing school or work (B), and impact of varying the duration of missed school or work days (100% probability of missing) (C).

Figure 2.

Total annual cost of norovirus outbreaks (societal perspective) by mode of transmission for outbreaks occurring in a long-term care/nursing home setting (A) or any nonhealthcare setting (B).

Figure 3.

Total annual cost of norovirus outbreaks (societal perspective) by mode of transmission for outbreaks occurring in a nonhealthcare setting, specifically in a school/university (A), daycare (B), office/business (C), or restaurant (D) setting.

Figure 4.

Annual costs of sporadic norovirus illnesses in the community varying with incidence (per 1000 population), broken down by direct medical costs (A), and productivity losses varying with norovirus-associated mortality risk (B), the probability of missing school or work (C), and the probability and duration of missing school or work (D).