Impact of Respiratory Syncytial Virus on Child, Caregiver, and Family Quality of Life in the United States: Systematic Literature Review and Analysis

Abstract

Background: Respiratory syncytial virus (RSV), a leading cause of lower respiratory tract infection in US children, reduces quality of life (QOL) of children, their caregivers, and families.

Methods: We conducted a systematic literature review in PubMed, EconLit, and other databases in the United States of articles published since 2000, derived utility lost per RSV episode from cohort studies, and performed a systematic analysis.

Results: From 2262 unique citations, 35 received full-text review and 7 met the inclusion criteria (2 cohort studies, 4 modeling studies, and 1 synthesis). Pooled data from the 2 cohort studies (both containing only hospitalized premature infants) gave quality-adjusted life-year (QALY) losses per episode of 0.0173 at day 38. From the cohort study that also assessed caregivers' QOL, we calculated net QALYs lost directly attributable to RSV per nonfatal episode from onset to 60 days after onset for the child, caregiver, child-and-caregiver dyad of 0.0169 (167% over prematurity alone), 0.0031, and 0.0200, respectively.

Conclusion: Published data on QOL of children in the United States with RSV are scarce and consider only premature hospitalized infants, whereas most RSV episodes occur in children who were born at term and were otherwise healthy. QOL studies are needed beyond hospitalized premature infants.

Keywords: United States; caregiver; infant; premature; quality of life; quality-adjusted life-year (QALYs); respiratory syncytial virus (RSV); systematic review; utility.

Figure 1.

PRISMA flowchart. Abbreviations: CDSR, Cochrane Database of Systematic Reviews; DARE, Database of Abstracts of Reviews of Effects; HTA, Health Technology Assessment Database; NHS EED, National Health Service Economic Evaluation Database; PEDE, Pediatric Economic Database Evaluation; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; ProQuest D&T, ProQuest Dissertations and Theses Global.

Figure 2.

Burden of RSV episode in infants/young children with a history of prematurity (data derived from Leidy et al [21]): (A) estimated absolute QALY burden of an RSV episode and (B) estimated incremental health burden relative to prematurity. Abbreviations: QALY, quality-adjusted life-year; RSV, respiratory syncytial virus.

Figure 3.

Quality of life in cohort studies. A, Pooling and analysis of the originally reported average QOL of the cohort studies combined [21, 22], and (B) cumulative QALY loss (solid line) and its slope (derivative, broken line). A, Symbols show dates for which each cohort contributed data (triangles denote control cohort, squares the Leidy et al RSV cohort [21], and circles the Pokrzywinski et al RSV cohort [22]). Labeled values (estimated QOL values) refer to the discharge date (day 6), the last common follow-up date between the 2 studies (day 38), and the end of comparative data (day 61). The extrapolated QOL score in (A) for day 0 was estimated to be 52.4 in the RSV group and improved to 87.0 by day 66. The control group started at a score of 90.9 and improved by 3.5 points by day 61. Using both studies, the cumulative loss was 0.0173 on day 38, the last time point with 2 QOL values. The cumulative line in (B) shows a steep rise in the first part of the episode, and a more moderate, but constant, rate of rise in the second part of the episode. The slope line remains above zero, however, even in the second part of the episode. This shows that the longer the period of follow-up of these premature infants with RSV, the greater the cumulative loss. It is possible that this pattern is a result of their prematurity and speaks to the need for RSV assessments in term infants. Abbreviations: QALY, quality-adjusted life-year; QOL, quality of life; RSV, respiratory syncytial virus.