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.

中文翻译：

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估计英国诺如病毒相关胃肠炎的医院负担及其未入院患者的机会成本。

背景 诺如病毒给医疗保健系统带来了巨大的负担，包括感染患者、疾病爆发、感染控制床位空置以及工作人员因感染缺勤等。在床位占用率较高的环境中，由于床位不足而无法入院的患者会产生机会成本。随着几种针对诺如病毒的治疗方法和疫苗正在开发中，量化预期的经济负担是及时的。方法 使用英国公共卫生部门收集的感染性和非感染性胃肠道医院事件统计代码和胃肠道病原体实验室报告，对英格兰诺如病毒相关胃肠炎住院患者的数量进行建模。诺如病毒的超额住院时间是通过多州模型和当地疫情数据估算的。空置床位天数和工作人员缺勤情况是根据国家疫情监测估算得出的。传统上使用会计支出和工资来评估负担，我们使用一种新颖的方法将其与放弃患者的机会成本进行对比。结果 2013年7月至2016年6月期间，17.7%（95%置信区间[CI]，15.6%～21.6%）的原发性胃肠道诊断和23.8%（95% CI，20.6%～29.9%）的继发性胃肠道诊断由诺如病毒引起。每年，诺如病毒导致 290000 个（四分位距，282000-297000）个占用和空置床位天数估计中位数导致 57800 名患者流离失所。国家卫生服务的常规成本达到 1.076 亿英镑；经济负担约为 2.977 亿英镑，每年损失 6300 个质量调整生命年。结论 在英国，诺如病毒目前是造成胃肠道医院负担的第二大因素。由于预计的影响比之前估计的更大，对于诺如病毒等疾病来说，改善相关机会成本的捕获似乎势在必行。