Anand Krishnan: Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India. ORCID
Kusum Shekhawat: Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
Ismael R Ortega-Sanchez: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Suman Kanungo: Indian Council of Medical Research,National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
Prabu Rajkumar: Indian Council of Medical Research, National Institute of Epidemiology, Chennai, Tamil Nadu, India. ORCID
Sumit Dutt Bhardwaj: Indian Council of Medical Research,National Institute of Virology, Pune, India.
Rakesh Kumar: Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
Aslesh Ottapura Prabhakaran: Influenza Program, Centers for Disease Control and Prevention, New Delhi, Delhi, India. ORCID
Giridara Gopal: Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
Alok Kumar Chakrabarti: Virology, Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India. ORCID
Girish Kumar Chethrapilly Purushothaman: Indian Council of Medical Research, National Institute of Epidemiology, Chennai, Tamil Nadu, India. ORCID
Varsha Potdar: Indian Council of Medical Research,National Institute of Virology, Pune, India.
Byomkesh Manna: Indian Council of Medical Research,National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
Radhika Gharpure: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. ORCID
Ritvik Amarchand: Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
Avinash Choudekar: Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Kathryn E Lafond: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Lalit Dar: Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Uttaran Bhattacharjee: Indian Council of Medical Research,National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
Eduardo Azziz-Baumgartner: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Siddhartha Saha: Influenza Program, Centers for Disease Control and Prevention, New Delhi, Delhi, India.
Introduction: Advocacy for the provision of public health resources, including vaccine for the prevention of acute respiratory illnesses (ARIs) among older adults in India, needs evidence on costs and benefits. Using a cohort of community-dwelling adults aged 60 years and older in India, we estimated the cost of ARI episode and its determinants. Methods: We enrolled 6016 participants in Ballabgarh, Chennai, Kolkata and Pune from July 2018 to March 2020. They were followed up weekly to identify ARI and classified them as acute upper respiratory illness (AURI) or pneumonia based on clinical features based on British Thoracic Society guidelines. All pneumonia and 20% of AURI cases were asked about the cost incurred on medical consultation, investigation, medications, transportation, food and lodging. The cost of services at public facilities was supplemented by WHO-Choosing Interventions that are Cost-Effective(CHOICE) estimates for 2019. Indirect costs incurred by the affected participant and their caregivers were estimated using human capital approach. We used generalised linear model with log link and gamma family to identify the average marginal effect of key determinants of the total cost of ARI. Results: We included 2648 AURI and 1081 pneumonia episodes. Only 47% (range 36%-60%) of the participants with pneumonia sought care. The mean cost of AURI episode was US$13.9, while that of pneumonia episode was US$25.6, with indirect costs comprising three-fourths of the total. The cost was higher among older men by US$3.4 (95% CI: 1.4 to 5.3), those with comorbidities by US$4.3 (95% CI: 2.8 to 5.7) and those who sought care by US$17.2 (95% CI: 15.1 to 19.2) but not by influenza status. The mean per capita annual cost of respiratory illness was US$29.5. Conclusion: Given the high community disease and cost burden of ARI, intensifying public health interventions to prevent and mitigate ARI among this fast-growing older adult population in India is warranted.
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