Cost of Respiratory Syncytial Virus-Associated Acute Lower Respiratory Infection Management in Young Children at the Regional and Global Level: A Systematic Review and Meta-Analysis

Abstract

Background Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory infection (ALRI) in young children aged <5 years. Methods We aimed to identify the global inpatient and outpatient cost of management of RSV-ALRI in young children to assist health policy makers in making decisions related to resource allocation for interventions to reduce severe morbidity and mortality from RSV in this age group. We searched 3 electronic databases including Global Health, Medline, and EMBASE for studies reporting cost data on RSV management in children under 60 months from 2000 to 2017. Unpublished data on the management cost of RSV episodes were collected through collaboration with an international working group (RSV GEN) and claim databases. Results We identified 41 studies reporting data from year 1987 to 2017, mainly from Europe, North America, and Australia, covering the management of a total of 365 828 RSV disease episodes. The average cost per episode was €3452 (95% confidence interval [CI], 3265–3639) and €299 (95% CI, 295–303) for inpatient and outpatient management without follow-up, and it increased to €8591(95% CI, 8489–8692) and €2191 (95% CI, 2190–2192), respectively, with follow-up to 2 years after the initial event. Conclusions Known risk factors (early and late preterm birth, congenital heart disease, chronic lung disease, intensive care unit admission, and ventilator use) were associated with €4160 (95% CI, 3237–5082) increased cost of hospitalization. The global cost of inpatient and outpatient RSV ALRI management in young children in 2017 was estimated to be approximately €4.82 billion (95% CI, 3.47–7.93), 65% of these in developing countries and 55% of global costs accounted for by hospitalization. We have demonstrated that RSV imposed a substantial economic burden on health systems, governments, and the society.

Health and economic burden of respiratory syncytial virus (RSV) disease and the cost-effectiveness of potential interventions against RSV among children under 5 years in 72 Gavi-eligible countries

“…Due to the absence of specific cost data for RSVassociated ALRI in LICs and LMICs [23], we bridged cost data for an outpatient visit, cost per bed-day in the hospital, and length of stay in the hospital (LoS) for pneumonia from a recent systematic review [17], as 60% of the published studies on pneumonia costs were conducted in South East Asia and Africa (covering 8 of the 72 countries). Country-specific outpatient and inpatient data were used where possible.…”

“…More than one third of the RSV-associated disease burden occurs in the first year of life. Using a 3% discount rate, the treatment costs total $611 million [95% PI 327-1110 13 15 Discounted YLDs 16 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] 26 [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] 12 [8][9][10][11][12][13][14][15][16][17][18] 13 [9][10][11][12][13][14]…”

Prefusion RSV F Immunization Elicits Th2-Mediated Lung Pathology in Mice When Formulated With a Th2 (but Not a Th1/Th2-Balanced) Adjuvant Despite Complete Viral Protection

“…In children >5 years of age, RSV causes an estimated 33 million acute LRTI annually, with over 3 million episodes requiring hospitalization ( 4 ). In 2017, the global cost estimate for inpatient and outpatient RSV LRTI management in young children (<5 years of age) was ~4.8 billion euros (equivalent to ~$5.2 billion USD) ( 5 ). In addition to young children, RSV is a common cause of severe respiratory disease in the elderly and those who are immunocompromised ( 6 – 8 ).…”

Estimating the Economic Impact of Respiratory Syncytial Virus and Other Acute Respiratory Infections Among Infants Receiving Care at a Referral Hospital in Malawi

“…Cost data for infant ARIs are sparse in low-income countries and almost nonexistent for pathogens such as RSV, which disproportionately impacts young infants [ 10 ]. While the economic impact of RSV has been estimated [ 11 ], current evaluations have relied on costs of other pathogens or imputed RSV costs based on assumptions.…”

“…In India, the total direct cost of an ARI episode for a hospitalized child ranged between $54 and $135 [ 14 ]. A more recent systematic review on the cost of managing severe pneumonia across LMICs estimated $51.70 for outpatients and $242.70 for inpatients [ 10 ].…”