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[Preprint]. 2024 Jul 17:2024.07.17.24310217.
doi: 10.1101/2024.07.17.24310217.

Cost per episode of diarrhea and respiratory syncytial virus (RSV) in 128 low- and middle-income countries: how well do disease-specific and WHO-CHOICE estimates align?

Xiao Li  1   2 , Joke Bilcke  1 , Ernest O Asare  2   3 , Catherine Wenger  3 , Jiye Kwon  2   3 , Louis Bont  3   4 , Philippe Beutels  1 , Virginia E Pitzer  2   3
Affiliations

Cost per episode of diarrhea and respiratory syncytial virus (RSV) in 128 low- and middle-income countries: how well do disease-specific and WHO-CHOICE estimates align?

Xiao Li et al. medRxiv. .

Abstract

Objective: Non-disease-specific WHO-CHOICE unit costs are often used in cost and cost-effectiveness studies in the absence of country-specific data. This study aims to compare reported country-specific disease costs and the corresponding WHO-CHOICE estimates. We use generically defined "diarrhea" (including rotavirus diarrhea) and pathogen-specific "respiratory syncytial virus (RSV)" disease as examples.

Methods: We updated systematic reviews for both diseases in low-income (LICs), lower-middle-income (LMICs) and upper-middle-income (UMICs) countries. Diarrheal (including a sub-analysis of rotavirus-specific) and RSV-specific outpatient and inpatient costs per episode were extracted and compared with WHO-CHOICE estimates in the same countries. If a consistent pattern of under- or over-estimation was identified, we quantified the magnitude of the discrepancy. All costs were updated to 2022 international dollar values.

Results: Out of 1975 new records identified, 23 new cost studies were included. Including previous reviews, we retained 31 diarrhea and 16 RSV studies for comparison. WHO-CHOICE based direct medical costs were similar for diarrheal disease including rotavirus diarrhea, but lower for RSV-related disease. We estimated the cost per episode of diarrhea and RSV in 128 countries. RSV outpatient cost were adjusted by multiplying WHO-CHOICE costs by 6.89 (95% uncertainty interval: 5.58-8.58) in LICs and LMICs and 5.87 (4.95-6.96) in UMICs; RSV inpatient costs were multiplied by 1.43 (1.01-2.01) and 1.36 (0.82-2.27), respectively.

Conclusion: WHO-CHOICE based costs should be used cautiously. They aligned well with studies for diarrheal disease, but underestimate costs of RSV-related disease. More country- and disease-specific cost data are needed, especially for RSV in LICs.

Keywords: RSV; child; cost; diarrhea; hospitalization; inpatient; low-income; middle-income; outpatient; rotavirus.

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Conflict of interest statement

Competing interests VEP was previously a member of the WHO Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC). Outside the submitted work, PB and LB reports grants from RESCEU and PROMISE, Innovative Medicines Initiative 2 of the European Commission, but they have not received any personal fees or other personal benefits. LB is the founding chairman of the ReSViNET Foundation. He also declares that he has regular interaction with pharmaceutical and other industrial partners. He has not received personal fees or other personal benefits. Outside the submitted work, his institute UMCU has received major funding (>€100,000 per industrial partner) for investigator-initiated studies from AstraZeneca, Sanofi, Janssen, Pfizer, MSD and MeMed Diagnostics. UMCU has received major funding from the Bill and Melinda Gates Foundation. UMCU has received major funding by Julius Clinical for participating in clinical studies sponsored by AstraZeneca, Merck and Pfizer. UMCU received minor funding (€1,000–25,000 per industrial partner) for consultation, DSMB membership or invited lectures by Ablynx, Bavaria Nordic, GSK, Novavax, Pfizer, Moderna, AstraZeneca, MSD, Sanofi, Janssen. Other authors declared no competing interests.

Figures

Figure 1:
Figure 1:. PRISMA flow diagram
Figure 2:
Figure 2:. Map of the number of studies for diarrhea (top) and RSV-related diseases (bottom) in low- and middle-income countries
White space: no data or high-income countries. Note: one study included 7 countries
Figure 3:
Figure 3:. Outpatient (left) and inpatient (right) direct medical costs for diarrheal disease.
Red dots represent the WHO-CHOICE estimates, while blue dots represent mean costs reported in the literature (iUSD in 2022 value). Black bars represent the 95% uncertainty intervals. Note: WHO-CHOICE estimates were not available for Zimbabwe and Palestine.
Figure 4:
Figure 4:. Outpatient (left) and inpatient (right) direct medical costs for RSV disease.
Red dots represent the WHO-CHOICE estimates, while blue dots represent mean costs reported in the literature (iUSD in 2022 value). Black bars represent the 95% uncertainty intervals.
See this image and copyright information in PMC

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