Infections from respiratory syncytial virus (RSV) in children requiring primary care led to significant societal economic costs from outpatient treatment and parental work absences in Europe, according to a study just published on Eurosurveillance.
The study sought to provide insights for public health policy and support costs and benefits analyses for RSV immunisation strategies. RSV infections are a leading cause of acute respiratory infections in children, with nearly all children experiencing at least one RSV infection by the age of 2. While some children develop a severe form of RSV disease that might require hospitalisation, most infections are managed in primary care.
Significant disparities in societal costs across age groups and countries
The study enrolled 3,414 children under the age of 5 with acute respiratory infection in Belgium, Italy, the Netherlands, Spain, and the United Kingdom (UK), of which 33% tested positive for RSV. Children were recruited through primary care physicians for RSV seasons 2020/21 (UK only), 2021/22 and 2022/23. Among children diagnosed with RSV, the cost of primary care treatment and parental work absences were assessed over 30 days through questionnaires filled in by parents. The calculation of overall economic burden comprised outpatient healthcare costs and missed work days by parents, with results stratified by country and by age the group of children diagnosed with RSV.
Researchers found that the RSV infections resulted in a significant economic burden, with costs varying substantially between the five countries taking part in this study: average outpatient healthcare costs per RSV episode ranged from 97 EUR in the Netherlands to 300 EUR in Spain, and were mostly driven by primary care visits. The costs for parental absence from work ranged from 454 EUR in the UK to 994 EUR in Belgium.
The main sources of costs were repeated visits to primary care physicians and parents missing work to care for their sick children. Costs related to healthcare were higher for infants under the age of 1, while work absences among parents represented a higher proportion of costs among children between 1 to 5 years of age. Medication costs to treat RSV infections contributed the least to the overall economic burden across all countries and age groups.
The mean number of primary care visits per child varied from 1.4 in the Netherlands to 3.0 in Spain. There were wide disparities in hospitalisation rates, which ranged from 4% of infections leading to hospitalisation in the Netherlands and Italy to 44% in Belgium. However, this may have been due to the fact that Belgium included data on children in out-of-hours care. The proportion of children being prescribed medication ranged from 26% in the UK to 77% in Italy. Parental work absences varied considerably between countries, and ranged from 13% of parents reporting absences and a mean of 1.3 missed working days in Spain to 71% of parents missing work days with a mean of 4.1 days off in Belgium.
The study has some limitations. There may have been some selection bias by physicians in selecting children and the study only included costs within 30 days of the first doctor visit. The COVID-19 pandemic could also have affected data. While evidence suggests that self-reported work absence serves as a valid alternative to documented work absence, some assumptions were made in the data analysis due to incomplete information. Finally, based on existing research, all costs were assumed to be related to RSV regardless of possible infections with other viruses.
Findings crucial to define immunisation strategies
The disparities revealed in the data highlight the importance of considering country-specific cost estimates when defining RSV immunisation strategies. These can vary widely due to differences in healthcare systems, care-seeking behaviour and parental leave policies.
This study also addresses a critical gap in understanding the overall economic impact of childhood RSV infections, as most studies on the economic burden of RSV so far have focused on the costs associated with RSV-related hospitalisation and not included costs from primary care. While infections treated in primary care have lower healthcare costs, they still contribute significantly to the overall economic burden of RSV.
"Our findings are particularly timely in light of the recent introduction of RSV immunisation strategies for infants, and the ongoing development of several RSV vaccines for toddlers and older children," the authors stated.
