ECONOMIC COSTS OF LOWER RESPIRATORY TRACT INFECTIONS AMONG HOSPITALIZED PATIENTS IN SOUTHERN SRI LANKA: A PROSPECTIVE COHORT STUDY
Author(s)
Coralei E. Neighbors, MSc1, Hishi Ulak, BSc2, Ruvini Kurukulasooriya, PhD3, Sky Vanderburg, MD4, Gaya B. Wijayaratne, MD5, Nayani P. Weerasinghe, MD5, Champica K. Bodinayake, MD6, Ajith de S. Nagahawatte, MD5, Armstrong Obale, MSc7, Truls Østbye, MD, PhD, MPH8, Christopher W. Woods, MD, MPH7, L Gayani Tillekeratne, MD, MSc8.
1Population Health Sciences, Duke University School of Medicine, Durham, NC, USA, 2Duke University, Durham, NC, USA, 3Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, 4University of California San Francisco, San Francisco, CA, USA, 5Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, 6University of Ruhuna, Galle, Sri Lanka, 7Hubert-Yeargan Center for Global Health, Duke University, Durham, NC, USA, 8Duke Global Health Institute, Duke University, Durham, NC, USA.
1Population Health Sciences, Duke University School of Medicine, Durham, NC, USA, 2Duke University, Durham, NC, USA, 3Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, 4University of California San Francisco, San Francisco, CA, USA, 5Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, 6University of Ruhuna, Galle, Sri Lanka, 7Hubert-Yeargan Center for Global Health, Duke University, Durham, NC, USA, 8Duke Global Health Institute, Duke University, Durham, NC, USA.
OBJECTIVES: Lower respiratory tract infections (LRTIs) are the fourth leading cause of death worldwide and, in Sri Lanka, ranked third and fourth among causes of hospital deaths and hospitalization in 2022-2023. No prior study has quantified the episode-level economic burden of LRTIs in Sri Lanka. Despite free public healthcare, patients still incur substantial out-of-pocket (OOP) and productivity costs. We estimated direct and indirect costs of hospitalized LRTI episodes in southern Sri Lanka from a societal perspective, by phase of care and age group.
METHODS: We conducted a prospective cohort study of 1,268 patients (median age 58.0 years; IQR: 32.0-69.0) hospitalized with LRTIs at a public tertiary care hospital in Galle, Sri Lanka, from April 2018 to March 2021. Standardized questionnaires at enrollment and four weeks post-discharge captured direct OOP costs (consultations, medications, laboratory tests, and transportation) and indirect costs (lost productivity) across three phases: before, during, and after hospitalization. Healthcare system costs were estimated using Sri Lanka-specific WHO-CHOICE estimates and included in direct costs. All costs were inflation-adjusted to 2020 Sri Lankan Rupees and converted to 2020 United States Dollars.
RESULTS: The median total cost per hospitalized LRTI episode was USD 125.25, comprising median direct costs of USD 106.15 and indirect costs of USD 18.47. Before hospitalization, 69.6% of patients sought care; 23.2% sought additional care after discharge. Median length of stay was four days (IQR: 3-5), and 95.7% received antibiotics. Cohort-wide costs totaled USD 233,486. Median per-patient cost represented 13.2% of annual per-capita household income, with the highest median total cost among 6-10-year-olds.
CONCLUSIONS: Hospitalized LRTIs impose a substantial financial burden on households and the public healthcare system in southern Sri Lanka despite universal free public healthcare. These estimates can inform economic evaluations of preventive interventions, including vaccines targeting LRTI pathogens, and support health technology assessment in Sri Lanka.
METHODS: We conducted a prospective cohort study of 1,268 patients (median age 58.0 years; IQR: 32.0-69.0) hospitalized with LRTIs at a public tertiary care hospital in Galle, Sri Lanka, from April 2018 to March 2021. Standardized questionnaires at enrollment and four weeks post-discharge captured direct OOP costs (consultations, medications, laboratory tests, and transportation) and indirect costs (lost productivity) across three phases: before, during, and after hospitalization. Healthcare system costs were estimated using Sri Lanka-specific WHO-CHOICE estimates and included in direct costs. All costs were inflation-adjusted to 2020 Sri Lankan Rupees and converted to 2020 United States Dollars.
RESULTS: The median total cost per hospitalized LRTI episode was USD 125.25, comprising median direct costs of USD 106.15 and indirect costs of USD 18.47. Before hospitalization, 69.6% of patients sought care; 23.2% sought additional care after discharge. Median length of stay was four days (IQR: 3-5), and 95.7% received antibiotics. Cohort-wide costs totaled USD 233,486. Median per-patient cost represented 13.2% of annual per-capita household income, with the highest median total cost among 6-10-year-olds.
CONCLUSIONS: Hospitalized LRTIs impose a substantial financial burden on households and the public healthcare system in southern Sri Lanka despite universal free public healthcare. These estimates can inform economic evaluations of preventive interventions, including vaccines targeting LRTI pathogens, and support health technology assessment in Sri Lanka.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE48
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Work & Home Productivity - Indirect Costs
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Infectious Disease (non-vaccine)