Health care costs of hospitalization of young children for respiratory syncytial virus infections: a population-based matched cohort study

Abstract

Background: Respiratory syncytial virus (RSV) infection poses a substantial clinical burden among infants and young children. We sought to determine the health care costs of hospitalizations attributable to RSV in Ontario, Canada, from the health care payer perspective.

Methods: For this population-based matched cohort study, we identified children younger than 24 months who were or were not hospitalized with RSV infections in 2006-2016. We performed a cost-of-illness analysis using linked administrative health data, with subjects stratified by gestational age and congenital heart disease, and propensity score-matched on established risk factors. The primary outcome was attributable health care costs per patient, reflecting the difference in direct medical costs between the groups, calculated to 12 months postdischarge in 2020 Canadian dollars.

Results: We identified 14 608 RSV-infected children, matched to 72 040 controls. The adjusted attributable cost of hospitalized RSV was $134 931 900 over 10 years, or $9240 per patient (95% confidence interval [CI] $8790-$9690). Health care costs escalated 3 days before hospitalization, and persisted up to 12 months after discharge. Increased costs were associated with major comorbidities, but not extreme premature birth. The highest mean attributable cost per patient was in the presence of hemodynamically significant heart disease ($60 110, 95% CI $26 700-$93 060). Infants born at 36-43 weeks' gestation constituted the greatest overall cost burden at $117 886 720.

Interpretation: Although the greatest direct medical costs per patient hospitalized with RSV infection are among children with cardiac disease, the greatest overall cost burden is from children born at or near term, who are not targeted by current prophylaxis strategies. The substantial attributable health care costs of RSV can inform cost-effectiveness analyses of novel RSV vaccines and prioritization of health care resources.

Figure 1:

Identification of patients hospitalized with respiratory syncytial virus (RSV) and controls. Patients were matched with up to 5 controls, where possible. Ideally, 5 matches were found per case; in the event of fewer matches, a lower matching ratio was permitted.

Figure 2:

Frequency of cost per individual, compared between patients hospitalized with respiratory syncytial virus (RSV) and controls. Costs are represented on a logarithmic scale (2020 Canadian dollars).

Figure 3:

Cost over time between patients hospitalized with respiratory syncytial virus (RSV) and controls (2020 Canadian dollars). (A) Monthly mean costs per patient compared with control after discharge. (B) Monthly mean cost differences after discharge between patients and controls, stratified by cost component. Note: NACRS = National Ambulatory Care Reporting System, OHIP = Ontario Health Insurance Plan. “Other” costs include those attributed to the Ontario Drug Benefit, complex & continuing care, home care, capitation for family health organizations or networks and the Assistive Devices Program.