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Observational Study
. 2025 Apr 11:15:04092.
doi: 10.7189/jogh.15.04092.

Assessing the cost of illness of RSV and non-RSV acute respiratory infections in Nepali children

Neele Rave  1 , Arun K Sharma  2   3 , Ram H Chapagain  4   3 , Rupesh Shrestha  2 , An Nguyen  5 , Clint Pecenka  6 , Farina L Shaaban  1 , Prakash Joshi  4   3 , Louis J Bont  1 ; RSV GOLD III – Health Economics Study Group
Collaborators, Affiliations
Observational Study

Assessing the cost of illness of RSV and non-RSV acute respiratory infections in Nepali children

Neele Rave et al. J Glob Health. .

Abstract

Background: Low- and middle-income countries (LMICs) bear the greatest burden of the global respiratory syncytial virus (RSV) morbidity and mortality, but lack cost data to evaluate the health-economic impact of RSV burden on families, the healthcare system, and society. This prospective observational study was performed by the RSV GOLD III - Health Economic Research Group and estimated the costs associated with RSV illness in Nepal.

Methods: We collected healthcare resource utilisation data from children <2 years old fulfilling the World Health Organization (severe) acute respiratory infections ((S)ARI) case definition over one local respiratory season (July to November 2023) at two public hospitals in Nepal. We used hospital records and caregiver interviews to collect direct medical, direct non-medical, and indirect cost data to generate total per-patient costs.

Results: We included 730 patients with a mean age of 6.8 (standard deviation = 5.8) months. RSV infection was confirmed in 72.6% of the inpatients (n/N = 469/646) with SARI. The mean total cost per RSV episode was USD 43 (95% confidence interval (CI) = 25-62) for non-severe, USD 312 (95% CI = 293-332) for severe, and USD 664 (95% CI = 381-947) for life-threatened patients. Of the total costs, the healthcare system incurred USD 16 (36.3%), USD 58 (18.6%), and USD 57 (8.6%) in each category of illness. Household-level costs were 1.4% (USD 19) of the country's gross domestic product per capita for non-severe, 15.1% (USD 200) for severe, and 35.7% (USD 472) for life-threatened patients, with costs for inpatients often reaching catastrophic levels.

Conclusions: Our findings show a significant healthcare and economic burden of RSV illness in Nepal, highlighting the need to prioritise RSV prevention strategies. Our cost burden data can inform the modelling of costs and benefits of future RSV interventions in Nepal.

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Conflict of interest statement

Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose the following activities and/or relationships: LJB has regular interaction with pharmaceutical and other industrial partners. He has not received personal fees or other personal benefits. UMCU has received major funding (greater than EUR 100 000 per industrial partner) for investigator-initiated studies from AbbVie, MedImmune, Janssen Pharmaceuticals, the Bill & Melinda Gates Foundation, Nutricia (Danone), and MeMed Diagnostics. UMCU has received major cash or in-kind funding as part of the public-private partnership Innovative Medicines Initiative (IMI)–funded RESCEU (Respiratory Syncytial Virus Consortium in Europe) project from GlaxoSmithKline, Novavax, Janssen, AstraZeneca, Pfizer, and Sanofi. UMCU has received major funding by Julius Clinical for participating in the International Network For Optimal Resistance Monitoring of RSV study sponsored by MedImmune. UMCU has received minor funding for participation in trials by Regeneron Pharmaceuticals and Janssen from 2015 to 2017 (total annual estimate less than EUR 20 000). UMCU received minor funding for consultation and invited lectures by AbbVie, MedImmune, Ablynx, Bavarian Nordic, mAbxience, Novavax, Pfizer, and Janssen (total annual estimate less than EUR 20 000). LJB is the founding chair of the Respiratory Syncytial Virus Foundation (ReSViNET) Foundation. PATH receives funding from the Bill & Melinda Gates Foundation to support RSV-related work.

Figures

Figure 1
Figure 1
Flow diagram, showing the total numbers of outpatients and inpatients included and excluded from the study. RSV – respiratory syncytial virus.
See this image and copyright information in PMC

References

    1. Li Y, Wang X, Blau DM, Caballero MT, Feikin DR, Gill CJ, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022;399:2047–64. 10.1016/S0140-6736(22)00478-0 - DOI - PMC - PubMed
    1. Zhang S, Akmar LZ, Bailey F, Rath BA, Alchikh M, Schweiger B, et al. Cost of Respiratory Syncytial Virus-Associated Acute Lower Respiratory Infection Management in Young Children at the Regional and Global Level: A Systematic Review and Meta-Analysis. J Infect Dis. 2020;222:S680–S687. 10.1093/infdis/jiz683 - DOI - PubMed
    1. Dharel S, Shrestha B, Basel P.Factors associated with childhood pneumonia and care seeking practices in Nepal: further analysis of 2019 Nepal Multiple Indicator Cluster Survey. BMC Public Health. 2023;23:264. 10.1186/s12889-022-14839-6 - DOI - PMC - PubMed
    1. Chu HY, Katz J, Tielsch J, Khatry SK, Shrestha L, LeClerq SC, et al. Respiratory syncytial virus infection in infants in rural Nepal. J Infect. 2016;73:145–54. 10.1016/j.jinf.2016.05.007 - DOI - PMC - PubMed
    1. RSV GOLD—ICU Network collaborators Respiratory syncytial virus infection among children younger than 2 years admitted to a paediatric intensive care unit with extended severe acute respiratory infection in ten Gavi-eligible countries: the RSV GOLD-ICU Network study. Lancet Glob Health. 2024;12:e1611–9. 10.1016/S2214-109X(24)00269-9 - DOI - PubMed

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