Epidemiology and economic burden of Puumala virus infection in Styria, Austria, 2003 to 2024
Stefan Hatzl, Christina Geiger, Lisa Kriegl, Markus Keldorfer, Gernot Schilcher, Florian Krammer, Robert KrauseAbstract
Background
Hantavirus infections cause hemorrhagic fever with renal syndrome and impose a potential burden on healthcare systems. However, comprehensive economic data remain scarce. We quantified the inpatient economic burden of hospitalized patients with Puumala virus (PUUV) infections in Styria, Austria´s primary endemic region, to identify hospitalization costs and early admission predictors of costs.
Methods
This retrospective cost-of-illness study analyzed 1,049 serologically confirmed PUUV hospitalizations across 20 public hospitals in Styria, Austria between September 2003 and March 2024. Costs were estimated using the Austrian performance-oriented hospital financing (LKF) diagnosis-related-group-system, standardized to 2024-equivalent Euros using consumer-price-index deflation. Admission predictors of cost were assessed using multivariable γ-generalized-linear-modeling with multiple imputation. Temporal trends in length of stay were analyzed using weighted segmented linear regression.
Results
Cumulative inpatient cost was approximately €10.3 million (mean per-case: €9,788) for the entire study period of 21 years. Three epidemic years (2012, 2019, 2021) accounted for 53.6% of cases and over €5.2 million in expenditure, with peak annual costs reaching €1.93 million (0.274% of total Styrian inpatient expenditure) in 2012. Prolonged activated partial thromboplastin time (aPTT; cost-ratio 1.024 per second, 95% CI 1.019–1.030) and older age (CR 1.004 per year, 95%-CI 1.001–1.008) were independent admission-level predictors of higher cost. Median hospital length of stay declined by approximately 50% over the study period.
Conclusions
PUUV hospitalizations impose a sharply episodic but recurrent economic burden on regional healthcare systems. Admission aPTT and age independently predicted cost, but clinical outcomes were not modelled and these variables do not constitute a triage tool. Epidemic preparedness strategies are warranted.