Economic and health burden of severe respiratory syncytial virus infection among hospitalised children at three tertiary hospitals in Argentina, Brazil, and Colombia: a two-year prospective multicentre cohort study

Background Respiratory syncytial virus (RSV) is a leading cause of severe lower respiratory tract infection (LRTI) in young children, yet prospective data on its societal and health burden in Latin America remain scarce. We estimated the direct medical, direct non-medical, and indirect costs and the health burden (disability-adjusted life years, DALYs) of severe RSV-associated LRTI, compared with RSV-negative children hospitalised with severe LRTI, in three Latin American countries. Methods We conducted a prospective multicentre cohort study between May 2023 and May 2025 among children aged 1–59 months hospitalised with severe LRTI in three tertiary hospitals in Argentina, Brazil, and Colombia. RSV was confirmed by Reverse Transcription Polymerase Chain Reaction (RT-PCR). Individual-level data on healthcare utilisation, household out-of-pocket expenditures, and caregiver productivity losses were collected. Costs were estimated by bottom-up micro-costing and expressed in June 2025 purchasing power parity–adjusted US dollars (USD PPP). DALYs per episode were summarised by country, RSV status, and level of care. Findings Among 747 children, 368 (49%) were RSV-positive. Intensive care unit (ICU) admission was the main driver of both costs and DALYs: mean total societal costs per episode were two-to six fold higher for ICU than forward admissions (in Argentina, USD PPP 22,099 vs 3479 among RSV-positive children), and median DALYs were three-to five fold higher (0.0058 vs 0.0011). Costs varied widely across sites but differed minimally by RSV status; differences between RSV-positive and RSV-negative episodes were small and non-significant in all three sites (all 95% confidence intervals [CIs] included zero). Interpretation Severe RSV disease imposes a substantial economic and health burden across the three tertiary hospitals studied in Argentina, Brazil, and Colombia. ICU admission, rather than RSV status, is the main determinant of per-episode costs and DALYs, providing evidence to inform policy on RSV prevention. Funding Merck Investigator Studies Program (MISP).