Although lack of routine testing and limitations to current diagnostic testing likely lead to underreporting of respiratory syncytial virus, RSV still poses a substantial economic burden.
Respiratory syncytial virus (RSV) was found to be an economic burden despite probable underreporting due to lack of routine testing, according to a study published in Journal of Medical Economics.
RSV is a seasonal virus that affects children and older adults. Approximately 470,000 adults 60 years and older have experienced an RSV-associated hospitalization and 33,000 in-hospital deaths areassociated with RSV. The management of acute respiratory infections has been previously estimated but did not report respiratory pathogen-specific management costs, the authors of the present study noted. This systematic literature review aimed to summarize the economic burden of RSV infection in adults.
The researchers used PubMed, Embase, the Cochrane Library, PsycINFO, and EconLit to look for studies about the economic and health-related quality of life (HRQOL) outcomes in patients who had RSV infection as adults. There were no language or country restrictions for searches done, with the primary search encompassing studies from January 1, 2002, to May 18, 2022.
Studies were included if they reported economic outcomes for adults with or without comorbidities. These economic outcomes of interest included health care resource utilization related to RSV, which includes intensive care unit (ICU) admission and mechanical ventilation (MV) use. General reviews were excluded in this review. Study type, patient population characteristics, follow-up period, cost outcomes, and proportion of patients that needed admission to the ICU, MV, or a higher level of care at discharge were all data used from the included studies. Cost outcomes were all converted to United States currency inflated to 2022.
The review encompassed 65 sources (55 articles and 10 conference abstracts), including studies from North America, South America, Europe, Asia, and Oceania. The 42 economic burden studies consisted of 15 on cost burden in adults with RSV infections, 28 that presented ICU admission and/or MV use, and 12 that presented a need for a higher level of care at discharge.
The 15 studies on cost burden came mostly from the United States (n = 9), but also included 1 study each from Europe, China, New Zealand, and the Republic of Korea; 2 were from Canada.
In 2 studies, the national direct cost burden from hospitalizations due to RSV in the United States were estimated. The first of these studies found that the mean total hospitalization costs for the US population in 2019 was $1.3 billion. The highest mean hospitalization costs came from those aged 18 to 49 years and the highest cost burden from those 65 years and older. The second study found a similar estimate of $1.5 to $1.8 billion mean hospitalization costa and $3.3 to $4.0 billion for adults 60 years and older.
Other studies that evaluated cost burden found that the highest mean incremental all-cause cost per cases of RSV were from adults 65 years and older. Short-term incremental costs were also found to be the highest in patients aged 50 to 64 years. Studies that reported on all-cause direct costs found a wide range; from as low as $8049 to as high as $58,117. The lowest cost estimate was from a study in the United States, estimating direct costs of $8049 to $12,125 per hospitalization for RSV. Cost estimates from Canada were the most similar to the United States.
Adults deemed high risk were also evaluated for cost burden. The second highest weekly direct all-cause costs after diagnosis of RSV were found in adults aged 18 to 59 years ($10,170). This age group also had the second greatest increase in mean weekly all-cause costs after diagnosis of RSV ($8349). A second study found that hospitalized high-risk patients accounted for the highest total costs ($49,108) 180 days after diagnosis of RSV.
Cost by comorbidity was only evaluated in 1 study, and it found that patients with cardiovascular disease cost an additional $3237 compared with patients without. Patients who had chronic liver disease had increased costs of $5883, and patients with chronic kidney disease, $936. Studies that evaluated the cost differential between RSV infection and influenza found that hospitalizations for RSV cost from $713 to $38,800 more than hospitalizations for influenza.
Overall rates of comorbidities were not reported in all studies, which limited the ability to analyze by severity of those comorbidities. Half of the studies included based the diagnosis of RSV on diagnosis codes rather than laboratory confirmation. Further, some cost types could have been excluded, all marking limitations on these findings.
The researchers concluded that a substantial economic burden stems from an RSV infection, even with potential underreporting of RSV infections more broadly.
Grace M, Colosia A, Wolowacz S, Panozzo C, Ghaswalla P. Economic burden of respiratory syncytial virus infection in adults: a systematic literature review. J Med Econ. Published online May 11, 2023. doi:10.1080/13696998.2023.2213125