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. 2022 Aug 15;226(Suppl 2):S225-S235.
doi: 10.1093/infdis/jiac172.

Cost of Respiratory Syncytial Virus Infections in US Infants: Systematic Literature Review and Analysis

Diana M Bowser  1 , Katharine R Rowlands  1 , Dhwani Hariharan  1 , Raíssa M Gervasio  1 , Lauren Buckley  1 , Yara Halasa-Rappel  1 , Elizabeth L Glaser  1 , Christopher B Nelson  2 , Donald S Shepard  1
Affiliations

Cost of Respiratory Syncytial Virus Infections in US Infants: Systematic Literature Review and Analysis

Diana M Bowser et al. J Infect Dis. .

Abstract

Background: Limited data are available on the economic costs of respiratory syncytial virus (RSV) infections among infants and young children in the United States.

Methods: We performed a systematic literature review of 10 key databases to identify studies published between 1 January 2014 and 2 August 2021 that reported RSV-related costs in US children aged 0-59 months. Costs were extracted and a systematic analysis was performed.

Results: Seventeen studies were included. Although an RSV hospitalization (RSVH) of an extremely premature infant costs 5.6 times that of a full-term infant ($10 214), full-term infants accounted for 82% of RSVHs and 70% of RSVH costs. Medicaid-insured infants were 91% more likely than commercially insured infants to be hospitalized for RSV treatment in their first year of life. Medicaid financed 61% of infant RSVHs. Paying 32% less per hospitalization than commercial insurance, Medicaid paid 51% of infant RSVH costs. Infants' RSV treatment costs $709.6 million annually, representing $187 per overall birth and $227 per publicly funded birth.

Conclusions: Public sources pay for more than half of infants' RSV medical costs, constituting the highest rate of RSVHs and the highest expenditure per birth. Full-term infants are the predominant source of infant RSVHs and costs.

Keywords: Medicaid; RSV; economic cost; gestational age; hospitalization; infant; premature; respiratory syncytial virus; systematic analysis; systematic literature review.

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Conflict of interest statement

Potential conflicts of interest. D. M. B., K. R. R., D. H., R. M. G., Y. H.-R., and E. L. G. were supported in part under an agreement between Sanofi and Brandeis University, but none received any direct funding nor in-kind support from the sponsors. C. B. N. is an employee of Sanofi and may hold shares and/or stock options in the company. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
PRISMA diagram. Abbreviations: CDSR, Cochrane Database of Systematic Reviews; DARE, Database of Abstracts of Reviews of Effects; HTA, Health Technology Assessment; NHS EED, National Health Service Economic Evaluation Database; PEDE, Paediatric Economic Database Evaluation; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; QOL, quality of life.
Figure 2.
Figure 2.
Mean (95% confidence interval) cost per respiratory syncytial virus hospitalization by weeks’ gestational age (wGA) group and payer in infants aged 0–11 months. Group definitions: full term (≥37 wGA), late preterm (35–36 wGA), early preterm (29–34 wGA), and extremely preterm (≤28 wGA).
Figure 3.
Figure 3.
Distribution of respiratory syncytial virus hospitalization (RSVH) of infants, aggregate infant RSVH costs, and births by (A) gestational age at birth and (B) payer type.
Figure 4.
Figure 4.
Breakdowns by payer (with 95% confidence interval) of (A) rates of respiratory syncytial virus (RSV) hospitalization per 1000 births and (B) expenditure on RSV treatment per birth by setting. The number at the top of each stacked bar shows the total for the payer (eg, $227 for public) and the number in the white box shows the inpatient expenditure for the payer (eg, $187 for public). The stacked bars represent the settings: inpatient (bottom, solid pattern of color representing the payer), outpatient (middle, diagonal stripes, also of color representing the payer), and emergency room (top, vertical stripes, also of color representing the payer).
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