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

Abstract

Background Respiratory syncytial virus (RSV) is a leading cause of respiratory illness among infants globally, yet economic burden data are scant, especially in low-income countries. Methods We collected data from 426 infants enrolled in the Queen Elizabeth Central Hospital respiratory disease surveillance platform to estimate the household and health system costs of managing RSV and other respiratory pathogens in Malawian infants. Total household cost per illness episode, including direct and indirect costs and lost income, was reported by parents/guardians at the initial visit and 6 weeks post discharge. The total cost to the health system was based on patient charts and hospital expenditures. All-cause acute respiratory infections (ARIs) and RSV costs for inpatient and outpatients are presented separately. All costs are in the 2018 US Dollar. Results The mean costs per RSV episode were $62.26 (95% confidence interval [CI]: $50.87-$73.66) and $12.51 (95% CI: $8.24-$16.79) for inpatient and outpatient cases, respectively. The mean cost per episode for all-cause ARIs was slightly higher among inpatients at $69.93 (95% CI: $63.06-$76.81) but slightly lower for outpatients at $10.17 (95% CI: $8.78-$11.57). Household costs accounted for roughly 20% of the total cost per episode. For the lowest-income families, household cost per inpatient RSV episode was about 32% of total monthly household income. Conclusions Among infants receiving care at a referral hospital in Malawi, the cost per episode in which RSV was detected is comparable to that of other episodes of respiratory illnesses where RSV was not detected. Estimates generated in this study can be used to evaluate the economic and financial impact of RSV and acute respiratory illness preventive interventions in Malawi.

Cost of childhood RSV management and cost-effectiveness of RSV interventions: a systematic review from a low- and middle-income country perspective

“…Among studies measuring outpatient care, cost estimates for direct costs per illness episode were $9.77 (Malawi) [ 38 ] and $665 (Thailand) [ 33 ] and corresponding estimates for indirect costs were $11.02 (Malawi) and $1074 (Thailand). For mild RSV cases or cases seen in the health facility ward, direct costs per episode were $805 (China) [ 36 ], $469 (Colombia) [ 25 ], $579 (Colombia) [ 37 ], and $358 (Malaysia) [ 32 ].…”

“…Indirect costs per episode were reported to be $681 (Colombia) [ 37 ]. For severe RSV cases in the intensive care unit cost per episode ranged from $92 (Malawi) [ 38 ] to $4,114 (Malaysia) [ 32 ]. One study in Mexico estimated cost-per-illness episodes to be $6922 [ 40 ], however, it should be noted these estimates were specifically for nosocomial RSV infection which may have different cost characteristics than the other studies, which evaluated community-acquired RSV cases.…”

Estimating the economic burden of typhoid in children and adults in Blantyre, Malawi: a costing cohort study

“…From a healthcare provider perspective, the cost to the Malawian government is substantial for typhoid. On a per-episode basis, the cost of typhoid exceeds the costs of other -admittedly more commonchildhood illnesses we have studied in the same context (25,26). Hospital investigations were major contributors, in part driven by blood culture costs, and these latter investigations may not be ubiquitously available where suspected (yet uncon rmed) typhoid cases occur.…”

Estimating the economic burden of typhoid in children and adults in Blantyre, Malawi: A costing cohort study

“…From a healthcare provider perspective, the cost to the Malawian government is substantial for typhoid. On a per-episode basis, the cost of typhoid exceeds the costs of other–admittedly more common–childhood illnesses we have studied in the same context [ 25 , 26 ]. Hospital investigations were major contributors, in part driven by blood culture costs, and these latter investigations may not be ubiquitously available where suspected (yet unconfirmed) typhoid cases occur.…”