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West Nile Virus Economic Impact, Louisiana, 2002

Armineh Zohrabian,* Martin I. Meltzer,* Raoult Ratard,† Kaafee Billah,* Noelle A. Molinari,* Kakoli Roy,* R. Douglas Scott II,* and Lyle R. Petersen*
*Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and †Louisiana Department of Health and Hospitals, New Orleans, Louisiana

Online Appendix. Questionnaire To Assess the Costs of West Nile Virus Illness for Adults

Date when the questionnaire is administered:      ----/----/---- (mo/day/year)

(Interviewer to introduce themselves)

Hello. My name is ________, and I am calling on behalf of the Centers for Disease Control and Prevention and the Louisiana Office of Public Health.

We are conducting a survey to determine the costs of the West Nile virus epidemic in Louisiana. This information will help your parish, State of Louisiana, and the Centers for Disease Control and Prevention in planning and strengthening disease control activities, such as mosquito control, to prevent future outbreaks.

I would like to ask you some questions about the expenses you have had because of your West Nile illness.

Participation in this survey is voluntary, and you may stop it at any time or you may choose not to answer any question that you do not care to answer. This survey is anonymous, and your name and other information that could identify you are not recorded on the questionnaire. After the interview nobody will be able to connect you to any of the answers that you give to us. We expect this interview to last about 20 minutes.

(If the patient is unable to participate in the study because of health reasons, ask if someone in the household could answer on the patient's behalf).

NOTE: If the patient is now deceased, mark the box below, and STOP THE INTERVIEW. Mention the following "I am very sorry to hear about the loss. I won't trouble you any further. Thank you for your time."

Patient is now deceased. Mark box ( )—otherwise proceed.

Note to the administrator: Please place an X in the parenthesis ( ) to indicate the answer.

The person answering the questionnaire is the:

1-( ) Patient      2-( ) Patient's spouse    3-( ) Son/Daughter       4-( ) Mother/Father

5-( ) Sister/Brother       6-( ) Friend      7-Other ____________________(please specify)

Gender of patient

( ) Male            ( ) Female

Patient's age: (in years)

________

Note: If the patient is 18 years or younger, STOP the interview, explain to the respondent that patients under 18 are not interviewed because of confidentiality reasons. Thank the respondent for their willingness to participate in the study.

Outpatient Medical Costs

I would like to ask you some questions about your visits to a doctor's office because of your West Nile illness. Please answer them as accurately as possible.

1. Because of your symptoms from the West Nile infection, how many times did you visit a doctor's office? If you have been hospitalized because of West Nile illness, this question is about visits to see a doctor before hospitalization.

___________times      (Indicate "0" if the patient did not visit a doctor, and "99" if unknown.)

(If "0", skip to question 4.A.)

2. To the best of your recollection, on average, how many minutes did you spend with the doctor on each of these visits? Estimate as best as possible.

______ minutes (Indicate"99" if unknown.)

3. How far, on average, did you have to travel, round trip, to see the doctor? Give the best estimate you can.

______ miles (Indicate "999" if unknown.)

Complications after Acute Care Hospitalization and Further Treatment

The following questions will be about health complications you may have experienced due to your West Nile illness, and about your further treatment after the hospitalization.

4.A. Did you spend time in a nursing home because of complications caused by West Nile illness?

( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

            (If "No," "Don't know," or "Refuse to answer," skip to question 5.)

4.B. How many days or months in total did you spend in the nursing home because of your West Nile illness? Estimate as best as possible.

____________days     (If still in the nursing home, indicate the number of days so far and check here: ( ).)

5. Because of the symptoms of your WNV illness, did you stay overnight for treatment in a rehabilitation center (other than the nursing home or hospital)?

1- Yes 2- No (SKIP to 6) 9- Don't know (SKIP to 6) 7- Refused (SKIP to 6)

5.A. How many nights in total did you spend in a rehabilitation center? Give the best estimate.

_____________nights (If still in a rehabilitation center, indicate the number of nights so far and check here: ( ).)

5.B. From the list I will read to you, indicate the type of treatments that you received during your stay in the rehabilitation center. You may indicate more than one treatment.

            1- Physical therapy

            2- Speech therapy

            3- Occupational therapy

            4- Other: please specify ____________________________________

6. Since the first time you were hospitalized, were you hospitalized again for health complications that were related to your West Nile illness?

            ( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

            (If "No," "Don't know," or "Refuse to answer," skip to question 7.)

6.A. What was the diagnosis for your second hospitalization? (If exact diagnosis is unknown, ask patient/respondent to explain reason for hospitalization as precisely as possible.)

            ______________________________________________________________________

            ______________________________________________________________________

6.B. How many nights did you stay in this hospital? Estimate as best as possible.

            ________________ nights (Indicate 999 if unknown.)

7. Because of your symptoms from West Nile illness, did you visit a physical therapist? If you received physical therapy during your overnight stay in a hospital or rehabilitation center, do not include it here.

            ( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

            (If "No," "Don't know," or "Refuse to answer," skip to question 8.)

7.A. If "Yes," how many times did you visit a physical therapist after you left the hospital? Estimate as best as possible.

            _________ number of times (Indicate "999" if cannot estimate.)

7.B. If "Yes," to the best of your recollection, on average, how many minutes did you spend with the physical therapist on each of these visits? Estimate as best as possible.

            _________ minutes (Indicate "999" if cannot estimate.)

7.C. Approximately, how far did you have to travel, round trip, to see the physical therapist? Estimate as best as possible.

            ______ miles (Indicate "999" if unknown.)       

8. Did you visit a speech therapist because of your WN illness? If you received speech therapy during an overnight stay in a hospital or rehabilitation center, do not include it here.

            ( ) Yes              ( ) No               ( ) Don't know             ( ) Refuse to answer

            (If "No," "Don't know," or "Refuse to answer," skip to question 9.)

8.A. If "Yes," how many times did you visit a speech therapist after you left the hospital? If you received speech therapy during an overnight stay in a hospital or rehabilitation center, do not include it here. Estimate as best as possible.

            _________ number of times (Indicate "999" if cannot estimate.)

8.B. To the best of your recollection, on average, how many minutes did you spend with the speech therapist on each of these visits? Estimate as best as possible.

            _________ minutes (Indicate "999" if cannot estimate.)

8.C. Approximately, how far did you have to travel, round trip, to see the speech therapist? Estimate as best as possible.

            ______ miles (Indicate "999" if unknown.)       

9. Did you receive occupational therapy? If you received occupational therapy during an overnight stay in a hospital or rehabilitation center, do not include it here.

            ( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

            If "No," "Don't know," or "Refuse to answer," skip to question 10A.

9.A. If "Yes," how many times did you visit an occupational therapist? Estimate as best as possible.

            _________ number of times (Indicate "999" if cannot estimate.)

9.B. To the best of your recollection, on average, how many minutes did you spend with the occupational therapist on each of these visits? Estimate as best as possible.

            _________ minutes (Indicate "999" if cannot estimate.)

9.C. Approximately, how far did you have to travel, round trip, to see the occupational therapist? Estimate as best as possible.

            ______ miles (Indicate "999" if unknown.)

10.A. After you left the hospital, did you need equipment or medications, such as nebulizers (a machine that provides respiratory medicines) or home oxygen, to help you with respiratory problems caused by your WNV illness?

            ( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

            (If "No," "Don't know," or "Refuse to answer," skip to question 11.)

10.B. If "Yes," describe the equipment, type of medication, and amount of the medication or home oxygen that you used to help you with respiratory problems.

            ___________________________________________________________

            ___________________________________________________________

11. Since the time you left the hospital, because of your West Nile illness, about how many times have you visited a doctor such as a family doctor, general practitioner, or neurologist? Do not include doctor visits in a nursing home or rehabilitation center. Estimate as best as possible.

            ____________ number of times (Indicate 0 if no visits, and "99" if unknown.)

(If the answer is 0, skip to the next section, "Productivity losses," read aloud the introduction to that section, then ask question 12.)

11.A. Approximately how far did you have to travel, round trip, to see the doctor? Estimate as best as possible.

            ______ miles (Indicate "999" if unknown.)

11.B. To the best of your recollection, on average, how many minutes did you spend with the doctor on each of these visits?

            ______ minutes (Indicate"99" if unknown.)

Productivity Losses

Now I would like to ask you questions about your job and about the missed workdays because of your West Nile illness.

12. At the time you got sick with West Nile illness, were you working for pay?

            ( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

            (If "No," "Don't know," or "Refuse to answer," skip to question 24.A.)

13.       What was your occupation at the time you got sick with West Nile?

            _______________________ (Please specify.)

            ( ) Don't know

            ( ) Refused to answer

14. Did you change your occupation, stop working entirely, or take early retirement because of your West Nile illness?

            ( ) Yes              ( ) No               ( ) Don't know             ( ) Refuse to answer

If "Yes," specify your new occupation. If you took early retirement because of your West Nile illness, indicate "early retirement" as your answer.

            ______________________________________________________________________

            ______________________________________________________________________

15. How many days a week did you work during the month before you got sick with West Nile?

            ____________________ days

            ( ) Don't know

            ( ) Refused to answer

16. What was your income rate from work (do not include retirement pension, alimony, public assistance, etc.) at the time you got sick with West Nile? Estimate as best as possible. Indicate a payment rate, before taxes, that is easier for you, such as, weekly, monthly, or annual.

            $_____________/week (Indicate 99999 if can't estimate.) (Skip to question 18.)

            $_____________/month (Indicate 99999 if can't estimate.) (Skip to question 18.)

            $_____________/year (Indicate 99999 if can't estimate.) (Skip to question 18.)

            ( ) Don't know             (ASK question 17, then SKIP to question 24.A.)

            ( ) Refused to answer    (ASK question 17, then SKIP to question 24.A.)

17. How many workdays have you missed because of your West Nile illness?

            ____________________ days (Indicate 999 if unknown.)

            (Skip to question 24.A.)

18. Estimate the number of workdays missed due to your West Nile illness while you were paid. (Indicate income rate given in the answer to question 16.)

____________________ days (Indicate "0" if none, and "999" if unknown.)

( ) Don't know

( ) Refuse to answer

19. Has your income rate from work changed after your West Nile illness?

            ( ) Yes

            ( ) No (Skip to question 24.A.)

            ( ) Don't know (Skip to question 24.A.)

            ( ) Refuse to answer (Skip to question 24.A.)

20. If "Yes," is this change in your income due to your West Nile illness?

            ( ) Yes

            ( ) No

            ( ) Don't know

            ( ) Refuse to answer

21. How many days per week do you work to earn this new income rate?

            _________days

            (Indicate "0" if none, and "999" if unknown.)

22.A. For how many months have you worked at this new income rate?

            ________months

22.B. What is this new income rate (do not consider the income from retirement pension, alimony, public assistance, etc.)? Estimate as best as possible. Choose a rate before taxes that is easier for you, such as weekly, monthly, or yearly.

            $_____________/week (Indicate 9999 if can't estimate.)

            $_____________/month (Indicate 99999 if can't estimate.)

            $_____________/year (Indicate 99999 if can't estimate.)        

            ( ) Don't know

            ( ) Refuse to answer

            (If the patient stopped working, indicate "0" and skip to question 24.A.)

23. How many workdays have you missed due to health reasons related to your West Nile illness during the period while earning this new income rate?

            ____________________ days (Indicate "0" if none, and "999" if unknown.)

24.A. Did someone else miss work to take care of you because of your West Nile illness?

            ( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

(If "No," "Don't know," or "Refuse to answer," skip to section Miscellaneous Services and Homecare, read aloud the introduction to that section, and proceed to question 28.A.)

24.B If "Yes," estimate the total number of workdays this person missed to take care of you when you were sick with West Nile. If there were more than one person, consider only the workdays missed by the one who took care of you most.

            __________ days ( Indicate 999 if unknown).

25. How many days a week did this person work right before he or she started to take care of you while you were sick with West Nile?

            ____________days (Indicate "9"[? Not 999?] if unknown.)

26. What was the occupation of the person who took care of you most when you were sick with West Nile? _________________________________

27. From the list I will read to you now, please specify one of the income categories that best describes the average annual income, before taxes, for the person who took care of you while you were sick with West Nile.

1)         $0

2)         $1–$20,000

3)         $20,001–$30,000

4)         $30,001–$40,000

5)         $ 40,001–$50,000

6)         $ 60,001–$70,000

7)         $ 70,001–$100,000

8)         $100,000 or greater

9)         Unknown

Miscellaneous Services and Homecare

Now I would like to identify any other expenses you may have had due to your West Nile illness. Please answer the questions as accurately as possible.

28.A. Did you use home health aide services, such as help with bathing or getting dressed, because of your West Nile illness?

            ( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

28.B. If "Yes," how much did you pay for the home health aide services? Give the best estimate.

______________ total $ (Indicate 9999 if unknown.)

29.A. Was your home modified to accommodate you because of this illness?

            ( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

29.B. If yes, how much did you pay to modify your home to accommodate you?

            ___________ total $ (Indicate 9999 if unknown.)

30. Did you use any miscellaneous services such as babysitting, house cleaning, and transportation due to your West Nile illness?

            ( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

30.A. If yes, please specify which services you used? _________________________

30.B. If "Yes," how much did you pay for these services?

            _____________________total $         (Indicate 9999 if unknown.)     

31. Please list any expenses you have had because of your West Nile illness that we have not asked about. Indicate the type of that expenditure and the total amount.

____________(total $) for _________________________________________

____________(total $) for _________________________________________

32A. Do you have any type of health insurance coverage, including Medicare or Medicaid?

            1- Yes 2- No(Skip to 33) 9- Don't Know(Skip to 33) 7- Refused(Skip to 33)

32.B. If yes, from the list I will read to you, indicate the type of health insurance that covered for the treatment or other expenses you had because of your WNV illness. You can indicate more than one type of insurance.

            1- Medicare

            2- Medicaid

            3- Health Insurance provided by employer

            4- Other. Please specify ____________________________________________

33. During the next 6 months, do you expect to get further treatment, such as physical therapy, speech therapy, or visiting a doctor because of any health problems caused by your West Nile illness?         

            ( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

34. During the next 6 months, do you think you will need to go to a nursing home because of health complications caused by your West Nile illness?

            ( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

Public Assistance and Disability Payments

Now I would like to ask you questions about public assistance and disability payments that you may be receiving, or expect to receive in the near future, connected with your West Nile illness.

35.A. Do you now receive any type of public assistance because of your West Nile illness (money from the state or federal government, social security, etc)?

            ( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

            (If "No," "Don't know," or "Refuse to answer," skip to question 36.A.)

35.B. If "Yes," list the names/types of the public assistance. Indicate the annual or monthly amount of the assistance, and the date when you started receiving it [enter the information in the table below].

36.A. Have you applied for any public assistance (which you are not yet receiving) because of health complications caused by your West Nile illness (money from state, or federal government, social security, etc.)?

            ( ) Yes               ( ) No              ( ) Don't know             ( ) Refuse to answer

36.B.    If yes, what are the names of the public assistance, the annual amount of the assistance from each source, and the date (month and year) when you will start receiving it? If you are not sure about the amount of the assistance, or the date you will start receiving it, give the best estimate.

Close interview: "Thank you sir/ma'am for your time and patience in helping us by answering our questions. I wish to repeat that your answers were recorded in an anonymous manner, and nobody will be able to connect you to any of the answers.

Do you have any questions about today's interview? [Interviewer should answer any direct questions. Anything that you don't know, encourage the respondent to contact us: Dr. Armineh Zohrabian, Centers for Disease Control and Prevention (CDC), phone: 970-266-3553, or Dr. Martin Meltzer, CDC, phone: 404-371-5353.]"

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This page posted August 30, 2004
This page last reviewed September 23, 2004

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