The economic burden of respiratory syncytial virus and other acute respiratory infections among children <2 years old seeking care at a tertiary facility in Accra, Ghana

Background: The global burden of the respiratory syncytial virus (RSV) disproportionately affects low- and middle-income countries (LMICs). The World Health Organization's Strategic Advisory Group of Experts on Immunisation recently recommended the global implementation of emerging RSV immunisation strategies to protect infants. Cost of illness data are needed to estimate the economic burden of RSV and evaluate the introduction of these immunisation strategies in LMICs. Here, we estimated RSV-associated costs in Ghana. Methods: We measured resource utilisation from the societal, health system, and household perspectives for children <2 years old receiving care for (severe) acute respiratory infections at Africa's third largest referral centre located in Accra, Ghana. During the 2023 respiratory season, children were tested for RSV using molecular point-of-care testing at inpatient and outpatient facilities. Direct medical, direct non-medical, and indirect cost data were collected via questionnaire-based caregiver interviews and gathered from hospital records. Interviews took place at the index visit, upon discharge, and during follow-up (four-six weeks post discharge). Results: Of 128 participating children, 59 (46%) and 69 (54%) received care at outpatient and inpatient facilities, respectively. RSV was detected in 58 (45%) children. From a societal perspective, the average cost per episode of RSV infection was USD 69 (95% confidence interval (CI) = 60-77) for outpatients and USD 488 (95% CI = 374-601) for inpatients. We estimated health system costs exceeding USD 30 and USD 200 on average for outpatient and inpatient care, respectively. Out-of-pocket costs borne by households were USD 32, (95% CI = 24-40) for outpatient care and USD 213 (95% CI = 158-269) for inpatient care. Household costs associated with RSV were equivalent to 88% (outpatients) and 592% (inpatients) of the Ghanaian monthly minimum wage in 2023. Conclusions: In this urban tertiary setting, we found a significant economic burden of medically attended RSV, carried by the Ghanaian health system and households. Our findings will be valuable to stakeholders in evaluating emerging interventions for RSV prevention in Ghana and comparable countries.