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
Authors: Zhang Shanshan , Akmar Lily Zainal , Bailey Freddie , Rath Barbara A , Alchikh Maren , Schweiger Brunhilde , Lucero Marilla G , Nillos Leilani T , Kyaw Moe H , Kieffer Alexia , Tong Sabine , Campbell Harry , Beutels Philippe , Nair Harish ,   RESCEU Investigators, Nair Harish , Campbell Harry , Shi Ting , Zhang Shanshan , Li You , Openshaw Peter , A Wedzicha Jadwicha , R Falsey Ann , Miller Mark , Beutels Philippe , Antillon Marina , Bilcke Joke , Li Xiao , Bont Louis , Pollard Andrew , Molero Eva , Martinon-Torres Federico , Heikkinen Terho , Meijer Adam , Fischer Thea Kølsen , van den Berge Maarten , Giaquinto Carlo , Mikolajczyk Rafael , Hackett Judy , Tafesse Eskinder , Lopez Antonio Gonzalez , Dieussaert Ilse , Dermateau Nadia , Stoszek Sonia , Gallichan Scott , Kieffer Alexia , Demont Clarisse , Cheret Arnaud , Gavart Sandra , Aerssens Jeroen , Wyffels Veronique , Cleenewerck Matthias , Fuentes Robert , Rosen Brian , Nair Harish , Campbell Harry , Shi Ting , Zhang Shanshan , Li You , Openshaw Peter , A Wedzicha Jadwicha , R Falsey Ann , Miller Mark , Beutels Philippe , Antillon Marina , Bilcke Joke , Li Xiao , Bont Louis , Pollard Andrew , Molero Eva , Martinon-Torres Federico , Heikkinen Terho , Meijer Adam , Fischer Thea Kølsen , van den Berge Maarten , Giaquinto Carlo , Mikolajczyk Rafael , Hackett Judy , Tafesse Eskinder , Lopez Antonio Gonzalez , Dieussaert Ilse , Dermateau Nadia , Stoszek Sonia , Gallichan Scott , Kieffer Alexia , Demont Clarisse , Cheret Arnaud , Gavart Sandra , Aerssens Jeroen , Wyffels Veronique , Cleenewerck Matthias , Fuentes Robert , Rosen Brian 
Published: December 2019

Abstract

Background
Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory infection (ALRI) in young children aged &lt;5 years.

Methods
We aimed to identify the global inpatient and outpatient cost of management of RSV-ALRI in young children to assist health policy makers in making decisions related to resource allocation for interventions to reduce severe morbidity and mortality from RSV in this age group. We searched 3 electronic databases including Global Health, Medline, and EMBASE for studies reporting cost data on RSV management in children under 60 months from 2000 to 2017. Unpublished data on the management cost of RSV episodes were collected through collaboration with an international working group (RSV GEN) and claim databases.

Results
We identified 41 studies reporting data from year 1987 to 2017, mainly from Europe, North America, and Australia, covering the management of a total of 365 828 RSV disease episodes. The average cost per episode was €3452 (95% confidence interval [CI], 3265–3639) and €299 (95% CI, 295–303) for inpatient and outpatient management without follow-up, and it increased to €8591(95% CI, 8489–8692) and €2191 (95% CI, 2190–2192), respectively, with follow-up to 2 years after the initial event.

Conclusions
Known risk factors (early and late preterm birth, congenital heart disease, chronic lung disease, intensive care unit admission, and ventilator use) were associated with €4160 (95% CI, 3237–5082) increased cost of hospitalization. The global cost of inpatient and outpatient RSV ALRI management in young children in 2017 was estimated to be approximately €4.82 billion (95% CI, 3.47–7.93), 65% of these in developing countries and 55% of global costs accounted for by hospitalization. We have demonstrated that RSV imposed a substantial economic burden on health systems, governments, and the society.