The economic burden of RSV-associated illness in children aged < 5 years, South Africa 2011–2016

Abstract

Background Data on the economic burden of RSV-associated illness will inform decisions on the programmatic implementation of maternal vaccines and monoclonal antibodies. We estimated the cost of RSV-associated illness in fine age bands to allow more accurate cost-effectiveness models to account for a limited duration of protection conferred by short- or long-acting interventions. Methods We conducted a costing study at sentinel sites across South Africa to estimate out-of-pocket and indirect costs for RSV-associated mild and severe illness. We collected facility-specific costs for staffing, equipment, services, diagnostic tests, and treatment. Using case-based data we calculated a patient day equivalent (PDE) for RSV-associated hospitalizations or clinic visits; the PDE was multiplied by the number of days of care to provide a case cost to the healthcare system. We estimated the costs in 3-month age intervals in children aged &lt; 1 year and as a single group for children aged 1–4 years. We then applied our data to a modified version of the World Health Organization tool for estimating the mean annual national cost burden, including medically and non-medically attended RSV-associated illness. Results The estimated mean annual cost of RSV-associated illness in children aged &lt; 5 years was US dollars ($)137,204,393, of which 76% ($111,742,713) were healthcare system incurred, 6% ($8,881,612) were out-of-pocket expenses and 13% ($28,225,.801) were indirect costs. Thirty-three percent ($45,652,677/$137,204,393) of the total cost in children aged &lt; 5 years was in the &lt; 3-month age group, of which 52% ($71,654,002/$137,204,393) were healthcare system incurred. The costs of non-medically attended cases increased with age from $3,307,218 in the &lt; 3-month age group to $8,603,377 in the 9–11-month age group. Conclusions Among children &lt; 5 years of age with RSV in South Africa, the highest cost burden was in the youngest infants; therefore, interventions against RSV targeting this age group are important to reduce the health and cost burden of RSV-associated illness.

Cost of illness due to Respiratory Syncytial Virus Acute Lower Respiratory Tract Infection Among Infants Hospitalized in Argentina

“…The medical costs associated with severe ALRTI due to RSV reported in this study were substantial for the public health system of Argentina. Not surprisingly, the medical costs shown were comparable with previous reports from other middle-income countries [37][38][39]44 . A detailed quanti cation of RSV-cost of illness is key for decision making, prioritizing future preventive interventions, and achieving effective allocation of health resources.…”

Age‐specific predictors of disease severity in children with respiratory syncytial virus infection beyond infancy and through the first 5 years of age

“…Epidemiologic studies and meta‐analyses from high‐, low‐, and middle‐income countries have defined the burden of RSV in children <5 years in terms of costs, hospitalization rates or mortality 7,9,12–16 . However, most studies have not include a detailed characterization of the risk factors associated with severe RSV infection beyond infancy.…”

“…Epidemiologic studies and meta-analyses from high-, low-, and middle-income countries have defined the burden of RSV in children <5 years in terms of costs, hospitalization rates or mortality. 7,9,[12][13][14][15][16] However, most studies have not include a detailed characterization of the risk factors associated with severe RSV infection beyond infancy. Furthermore, whether underlying comorbidities or additional factors influenced RSV disease severity according to age has not been fully defined.…”

Respiratory syncytial virus immunoprophylaxis: Novel opportunities and a call for equity

“…33 Altogether, this leads to a high-cost burden of RSV-associated illness in children < 5 years, estimated recently for South Africa at the mean annual level of 137 203 393 USD, of which 76% were incurred in the healthcare system. 34 The burden of RSV infections in elderly adults living in LMICs is also likely higher than in developed regions, where it was recently found to be higher than previously estimated, highlighting the need for prophylaxis efforts in this age group. 35 However, contrary to high-income countries, comprehensive data on morbidity and mortality in adults from LMICs is scarce due to a lack of surveillance systems, differences in healthcare settings, and healthcare-seeking behaviors.…”

“…According to one case‐series study, the mortality rate of HIV‐infected children hospitalized with RSV infection was as high as 20% 33 . Altogether, this leads to a high‐cost burden of RSV‐associated illness in children < 5 years, estimated recently for South Africa at the mean annual level of 137 203 393 USD, of which 76% were incurred in the healthcare system 34 . The burden of RSV infections in elderly adults living in LMICs is also likely higher than in developed regions, where it was recently found to be higher than previously estimated, highlighting the need for prophylaxis efforts in this age group 35 .…”