Estimating the economic burden of respiratory syncytial virus infections in infants in Vietnam: a cohort study

Abstract

Background Little information is available on the costs of respiratory syncytial virus (RSV) in Vietnam or other low- and middle-income countries. Our study estimated the costs of LRTIs associated with RSV infection among children in southern Vietnam. Methods We conducted a prospective cohort study evaluating household and societal costs associated with LRTIs stratified by RSV status and severity among children under 2 years old who sought care at a major pediatric referral hospital in southern Vietnam. Enrollment periods were September 2019–December 2019, October 2020–June 2021 and October 2021–December 2021. RSV status was confirmed by a validated RT-PCR assay. RSV rapid detection antigen (RDA) test performance was also evaluated. Data on resource utilization, direct medical and non-medical costs, and indirect costs were collected from billing records and supplemented by patient-level questionnaires. All costs are reported in 2022 US dollars. Results 536 children were enrolled in the study, with a median age of 7 months (interquartile range [IQR] 3–12). This included 210 (39.2%) children from the outpatient department, 318 children (59.3%) from the inpatient respiratory department (RD), and 8 children (1.5%) from the intensive care unit (ICU). Nearly 20% (105/536) were RSV positive: 3.9 percent (21/536) from the outpatient department, 15.7% (84/536) from the RD, and none from the ICU. The median total cost associated with LRTI per patient was US$52 (IQR 32–86) for outpatients and US$184 (IQR 109–287) for RD inpatients. For RSV-associated LRTIs, the median total cost per infection episode per patient was US$52 (IQR 32–85) for outpatients and US$165 (IQR 95–249) for RD inpatients. Total out-of-pocket costs of one non-ICU admission of RSV-associated LRTI ranged from 32%-70% of the monthly minimum wage per person (US$160) in Ho Chi Minh City. The sensitivity and the specificity of RSV RDA test were 88.2% (95% CI 63.6–98.5%) and 100% (95% CI 93.3–100%), respectively. Conclusion These are the first data reporting the substantial economic burden of RSV-associated illness in young children in Vietnam. This study informs policymakers in planning health care resources and highlights the urgency of RSV disease prevention.

The upcoming RSV vaccine: Assessing the potential effectiveness and cost-effectiveness of different vaccination strategies in China

“…In contrast to previous studies on RSV vaccination in middle-or low-income countries or regions, though the reasons for vaccination recommendations differ, the conclusions are convergent [11][12][13]30]. We focused on the health and productivity impacts of deaths, while previous researches opted for a lower vaccine price, possibly in uenced by ndings such as Global Alliance for Vaccines and Immunization (Gavi).…”

“…Natural background mortality was excluded from the model since the study period was limited to only one year. Considering that the follow-up duration of the clinical trial was approximately 6 months, it was assumed to represent the vaccination protection period, which aligned with the majority of published costeffectiveness literature [11][12][13].…”

Impact and cost-effectiveness of strategies to prevent respiratory syncytial virus (RSV) disease in Vietnam: A modelling study

“… New analysis of RSV-ALRI hospital admissions in Ho Chi Minh City (see methods). <3 months 25 % <6 months 51 % <9 months 64 % <12 months 72 % <2 years 87 % <5 years 100 % DALY weights RSV non-severe cases 0.051 0.032–0.074 GBD, 2019 [20] RSV severe cases 0.133 0.088–0.190 GBD, 2019 [20] Duration of illness (days) RSV non-severe cases 5 3–7 Hall et al [19] RSV severe cases 7 3–22 New analysis (Ho Chi Minh City) Cost per visit/admission (US$) RSV clinic visits 52 32–85 Do et al BMC Infect Dis 2023 [21] RSV hospital admissions 165 95–249 Do et al BMC Infect Dis 2023 [21] Impact of RSV mAb (infant) Program coverage *** 88 % 79 –97 % BCG, MICS report [27] , [28] Efficacy (RSV non-severe cases) 75 % 50–87 % AstraZeneca Press release [30] Efficacy (RSV severe cases) 77 % 50–90 % AstraZeneca Press release [30] Duration of protection (months) 5 4-6 AstraZeneca Press release [30] Impact of RSV vaccine (maternal) …”

Assessing the Long-Term Economic Impact of Wheezing Episodes After Severe RSV Disease in Children from Argentina: A Cost of Illness Analysis

“…However, the economic impact of recurrent wheezing as an association of severe RSV disease, has not yet been extensively explored in LMIC. While some research has been conducted on the clinical aspects of RSV infections and their associated costs in Argentina and other LMICs 23,24 , there is a considerable lack of comprehensive assessments regarding the long-term effects of RSV infection on healthcare resource utilization and associated costs 25,26 .…”