The economic impact of pediatric RSV-related lower respiratory tract infection in Germany: evidence from the PAPI study

BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections (LRTI) in infants and young children. While considerable research has described the clinical burden and direct medical costs of RSV in Germany, the broader economic impact remains poorly understood, particularly the burden on affected families and productivity losses associated with parental work absence. METHODS: The prospective, multicenter PAPI study was conducted across 12 hospitals and five pediatric practices in Germany during the 2021-2022 and 2022-2023 RSV seasons. Children under 24 months presenting with lower respiratory tract infections were tested for RSV. Health care resource use, parental expenses, and absenteeism were assessed through questionnaires and follow-up interviews. The human capital approach was used to estimate productivity losses. RESULTS: Of 1,607 hospitalized children, 918 (57.1%) tested positive for RSV and 714 were included in the analysis. In the outpatient setting, 286 of 1,442 cases (19.8%) were RSV-positive, with 250 included in the analysis. Among hospitalized RSV cases, 91.3% required additional primary care visits. Parental work loss was reported in 64.3% of hospitalized and 37.5% of outpatient cases. Mean productivity losses were €1,865 for hospitalized cases and €1,484 for outpatient cases associated with parental work loss. Productivity losses were higher for toddlers (aged 12-23 months) than infants (0-11 months), with hospitalized toddlers showing the highest mean loss of €2,584 per case involving parental work absence. CONCLUSIONS: This study demonstrates that RSV infections in children under two years impose a substantial economic burden on the German health care system and parents. The findings provide critical evidence to support decision-making on preventive strategies aimed at reducing RSV-related morbidity and its economic consequences in Germany.