Economic burden of children hospitalized with respiratory syncytial virus infection in Spain, 2016–2019

This retrospective observational study aimed to quantify the costs associated with hospitalized respiratory syncytial virus (RSV) in children <18 years admitted to the Spanish National Healthcare System between 2016 and 2019 and contrast them with the costs of unspecified bronchiolitis/bronchitis/pneumonia (UBP) and influenza. The mean cost per hospitalization episode was reported by age group, risk category and prematurity. Total annual hospitalization costs were calculated from population incidence rates and the mean cost per episode. A total of 41,934 children were hospitalized with RSV, 70,160 with UBP and 8525 with influenza during 2016-2019. The highest incidence of hospitalization for RSV, UBP, and influenza occurred among infants <6 months. The mean cost per episode was highest for RSV cases aged <6 months with at least one risk factor (€4760 high vs €2827 low risk), while the mean cost ranged from €3704-4352 for high-risk and €2687-3475 for low-risk children of other ages, and from €4300-44,594 for preterm infants. In the 0-5 months age group, the mean cost per episode for UBP was €4189 and €2666 for high and low risk, and for influenza it was €3134 and €2081, respectively; while the mean cost of co-infected RSV-influenza cases was €4809 and €2887, respectively. The mean total annual estimated cost for RSV for children aged 0-17 years was €39.3 M based only on reported cases, rising to €53.8 M if we correct for under-diagnosis and all RSV-attributable cases are considered. In contrast, the mean total annual cost for influenza was €5.9 M. Compared to influenza, RSV has a substantially higher economic burden; nevertheless, the Spanish immunization schedule recommends influenza vaccine between 6 and 59 months of age and RSV monoclonal antibody only for those aged <6 months. RSV immunization is still to be implemented in older children, considering that 37 % of RSV hospitalized patients were aged ≥6 months.