Burden and Cost of Hospitalization for Respiratory Syncytial Virus in Young Children, Singapore

Abstract

Respiratory syncytial virus (RSV) is the most common cause of pediatric acute lower respiratory tract infection worldwide. Detailed data on the health and economic burden of RSV disease are lacking from tropical settings with year-round RSV transmission. We developed a statistical and economic model to estimate the annual incidence and healthcare cost of medically attended RSV disease among young children in Singapore, using Monte Carlo simulation to account for uncertainty in model parameters. RSV accounted for 708 hospitalizations in children <6 months of age (33.5/1,000 child-years) and 1,096 in children 6-29 months of age (13.2/1,000 child-years). The cost of hospitalization was SGD 5.7 million (US $4.3 million) at 2014 prices; patients bore 60% of the cost. RSV-associated disease burden in tropical settings in Asia is high and comparable to other settings. Further work incorporating efficacy data from ongoing vaccine trials will help to determine the potential cost-effectiveness of different vaccination strategies.

Keywords: Singapore; bronchiolitis; disease burden; economic cost; economic modeling; lower respiratory tract infection; pneumonia; respiratory infections; respiratory syncytial virus; viruses.

Figure 1

Hospital admissions for respiratory syncytial virus and for bronchiolitis and pneumonia over time by age group, Singapore, 2005–2013.

Figure 2

Proportion of bronchiolitis and pneumonia admissions for pneumonia-related codes as contrasted with model predictions by age, Singapore, 2005–2013. Gray shading along the curve indicates 95% CI.

Figure 3

Estimated annual RSV-associated hospital admissions and costs for children <5 months of age (A–C) and children 6–29 months (D–F), Singapore, 2005–2013. Panels show estimated annual RSV-associated hospital admissions (panels A, D), total hospitalization costs by diagnosis (B, E), and full vs. subsidized costs (C, F). For panels C and F, shading indicates, from lightest to darkest: bronchiolitis, pneumonia without complications, pneumonia with complications. Point estimates and error bars representing medians and central 95% CI distributions were generated from 10,000 Monte Carlo simulations. B, bronchiolitis; P, pneumonia; PC, pneumonia with complications; RSV, respiratory syncytial virus; SGD, Singapore dollars.