Assessing the Long-Term Economic Impact of Wheezing Episodes After Severe RSV Disease in Children from Argentina: A Cost of Illness Analysis
Authors: Dvorkin Julia , Pecenka Clint , Sosa Emiliano , Sancilio Andrea , Dueñas Karina , Rodriguez Andrea , Rojas-Roque Carlos , Carruitero Patricia B. , Baral Ranju , Vodicka Elisabeth , Polack Fernando P. , Libster Romina , Caballero Mauricio T. 
Published: March 2024

Introduction

There is a lack of available data on the economic burden of wheezing episodes resulting from prior severe respiratory syncytial virus (RSV) infections in resource-constrained settings. This study aimed to assess the cost incurred for wheezing episodes during five years after a severe RSV infection in children from Argentina, considering both the public health system and societal perspectives.

Methods

A prospective cohort was conducted to assess the cost-of-illness (COI) linked to wheezing episodes after severe RSV disease in children from Buenos Aires, Argentina. Direct medical and non-medical costs were estimated, along with indirect costs per episode and patient. Data pertaining to healthcare resource utilization, indirect expenses, and parental out-of-pocket costs were obtained from research forms. The overall cost per hospitalization and health visits were calculated from the perspectives of the healthcare system and society. Costs were quantified in US dollars.

Results

Overall, 150 children aged between 12 and 60 months presented a total of 429 wheezing episodes. The median number of wheezing episodes per patient was 5 (IQR 3-7). The mean cost per wheezing episode was US$ 191.01 (95% confidence interval [CI] $166.37 – $215.64). The total cost per episode of wheezing was significantly higher (p<0.001) in infants under 12 months of age (207.43, 95%CI 154.3-260.6) compared to older toddler subgroups. The average cumulative cost associated to wheezing per patient was US$ 415.99 (95%CI $313.35 - $518.63). Considering both acute RSV disease and long-term wheezing outcomes the cumulative mean cost per patient was US$ 959.56 (95%CI $832.01-$1087.10).

Conclusions

This study reveals the economic impact of prolonged wheezing resulting from severe acute RSV infection on Argentina’s public health system and society. The estimates obtained serve as valuable inputs for informing cost-effectiveness analyses of upcoming RSV preventive interventions.

What is already known on this topic

Multiple studies demonstrate the association between severe acute lower respiratory tract infections caused by RSV in infancy with long-term obstructive pulmonary disease such as recurrent wheezing or asthma. Nevertheless, there is a lack of information regarding the economic impact of these frequent wheezing episodes in individuals who experienced hospitalization due to RSV disease early in life, particularly in low- and middle-income countries. To address this gap, we conducted a prospective cohort study to ascertain the cost of illness associated with wheezing episodes in children during their initial 5 years of life following a severe RSV infection within a low-income population in Buenos Aires, Argentina.

What this study adds

This study provides a comprehensive account of both medical and non-medical expenses associated with frequent wheezing episodes in childhood in low settings of Argentina, focusing on patients who experienced a severe RSV infection. Furthermore, we computed the total cost, encompassing the expenses associated with the initial severe RSV disease in those patients with long-term wheezing episodes.

How this study might affect research, practice or policy

The data produced in this study is important for estimating the economic impact of forthcoming preventive measures against RSV in low- and middle-income countries through cost-effectiveness studies. Health decision-makers can leverage this information for future decisions on implementing preventive policies against RSV in infancy.