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

• Published in: BMC medicine Vol. 21; no. 1; p. 146
• Main Authors: Moyes, Jocelyn, Tempia, Stefano, Walaza, Sibongile, McMorrow, Meredith L, Treurnicht, Florette, Wolter, Nicole, von Gottberg, Anne, Kahn, Kathleen, Cohen, Adam L, Dawood, Halima, Variava, Ebrahim, Cohen, Cheryl
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.04.2023; BioMed Central; BMC
• Subjects: Age; Analysis; Burden; Care and treatment; Caregivers; Child; Child health services; Child, Preschool; Children; Childrens health; Clinics; Confidence intervals; Consumer Price Index; Cost; Cost analysis; Cost control; Cost estimates; Costs; Costs and Cost Analysis; Demographic aspects; Economic aspects; Equipment costs; Financial Stress; GDP; Gross Domestic Product; Health care; Health care expenditures; Hospitalization; Humans; Illnesses; Infant; Low income groups; Medical care, Cost of; Monoclonal antibodies; Outpatient care facilities; Pneumonia; Respiratory illness; Respiratory syncytial virus; Respiratory syncytial virus infection; Respiratory Syncytial Virus Infections; South Africa - epidemiology; Surveillance; Vaccines; X-rays; South Africa; Respiratory illness; Respiratory syncytial virus; Burden; Children; Cost
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/s12916-023-02854-2

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. 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 < 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. The estimated mean annual cost of RSV-associated illness in children aged < 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 < 5 years was in the < 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 < 3-month age group to $8,603,377 in the 9-11-month age group. Among children < 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.