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Excess influenza hospital admissions and costs due to the 2009 H1N1 pandemic in England


  • Krystal Lau
  • Katharina Hauck
  • Marisa Miraldo


Influenza pandemics considerably burden affected health systems due to surges in inpatient admissions and associated costs. Previous studies underestimate or overestimate 2009/2010 influenza A/H1N1 pandemic hospital admissions and costs. We robustly estimate overall and age‐specific weekly H1N1 admissions and costs between June 2009 and March 2011 across 170 English hospitals. We calculate H1N1 admissions and costs as the difference between our administrative data of all influenza‐like‐illness patients (seasonal and pandemic alike) and a counterfactual of expected weekly seasonal influenza admissions and costs established using time‐series models on prepandemic (2004–2008) data. We find two waves of H1N1 admissions: one pandemic wave (June 2009–March 2010) with 10,348 admissions costing £20.5 million and one postpandemic wave (November 2010–March 2011) with 11,775 admissions costing £24.8 million. Patients aged 0–4 years old have the highest H1N1 admission rate, and 25‐ to 44‐ and 65+‐year‐olds have the highest costs. Our estimates are up to 4.3 times higher than previous reports, suggesting that the pandemic's burden on hospitals was formerly underassessed. Our findings can help hospitals manage unexpected surges in admissions and resource use due to pandemics.

Suggested Citation

  • Krystal Lau & Katharina Hauck & Marisa Miraldo, 2019. "Excess influenza hospital admissions and costs due to the 2009 H1N1 pandemic in England," Health Economics, John Wiley & Sons, Ltd., vol. 28(2), pages 175-188, February.
  • Handle: RePEc:wly:hlthec:v:28:y:2019:i:2:p:175-188
    DOI: 10.1002/hec.3834

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    References listed on IDEAS

    1. Frederick Chen & Amanda Griffith & Allin Cottrell & Yue-Ling Wong, 2013. "Behavioral Responses to Epidemics in an Online Experiment: Using Virtual Diseases to Study Human Behavior," PLOS ONE, Public Library of Science, vol. 8(1), pages 1-10, January.
    2. repec:hrv:hksfac:35014363 is not listed on IDEAS
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    1. Ewan Gray’s journal round-up for 27th April 2020
      by Ewan Gray in The Academic Health Economists' Blog on 2020-04-27 11:00:00


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    Cited by:

    1. Ian M. Trotter & Lu'is A. C. Schmidt & Bruno C. M. Pinto & Andrezza L. Batista & J'essica Pellenz & Maritza Isidro & Aline Rodrigues & Attawan G. S. Suela & Loredany Rodrigues, 2020. "COVID-19 and Global Economic Growth: Policy Simulations with a Pandemic-Enabled Neoclassical Growth Model," Papers 2005.13722,, revised Jun 2020.
    2. Peter Sivey & Richard McAllister & Hassan Vally & Anna Burgess & Anne-Maree Kelly, 2019. "Anatomy of a demand shock: Quantitative analysis of crowding in hospital emergency departments in Victoria, Australia during the 2009 influenza pandemic," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-11, September.

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