RSV-LRTI Associated With High Economic Burden in Adults

The cost of respiratory syncytial virus-lower respiratory tract illness (RSV-LRTI) requiring hospitalization or ambulatory care for adults is substantial and lasts beyond the acute illness phase, investigators reported in Open Forum Infectious Diseases.

Researchers estimated the attributable costs of RSV-LRTI in US adults, both during the acute phase of illness and up to 1 year after. Toward that end, they conducted a retrospective, observational, matched-cohort study analyzing data from the Merative MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits Databases.

Participants were adults at least 18 years of age with evidence of a medically attended episode of LRTI due to RSV from January 2017 through December 2018. Each patient with RSV-LRTI was matched with a comparison patient.

All-cause health care expenditures were calculated for patients with RSV-LRTI and comparison patients in the acute illness and long-term phase. Among hospitalized patients with RSV-LRTI, the acute phase included the index RSV hospitalization and 30-day postdischarge period, and the long-term phase included the 1-year period after the end of the 30-day postdischarge period. For ambulatory patients, the acute phase included the index episode, and the long-term phase included the 1-year period thereafter.

An RSV-LRTI episode was identified in 6554 patients, of whom 4526 were matched with comparison patients and included in the analysis. Participants had a mean (SD) age of 56 (18) years, and 61% were female. Of the cohort, 970 patients had hospitalized RSV-LRTI, 590 had ambulatory RSV-LRTI with emergency department visit (RSV-ED), and 2966 had physician office/hospital outpatient RSV (RSV-PO/HO).

Among the patients with a hospitalized episode, the mean all-cause health care expenditures in the acute phase of illness were $42,179 ($38,179-$46,194) for patients with RSV-LRTI compared with $5154 ($3984-$6605) for the comparison group, for overall attributable expenditures of $37,025 ($33,922-$40,068).

In patients with ambulatory episodes, acute phase expenditures were $4409 ($3975-$4885) for those with RSV-ED and $922 ($796-$1059) for those with RSV-PO/HO. The corresponding expenditures in comparison patients were $377 ($186-$598) and $201 ($134-$281), with total attributable expenditures of $4032 ($3696-$4396) and $721 ($612-$832), respectively.

After 1 year, the mean all-cause expenditures in the acute plus long-term phases were $101,532 ($90,689-$112,541) for RSV-hospitalized patients (vs $36,302 [$32,154-$41,060] for matched control); $48,701 ($32,253-$76,187) for those with RSV-ED (vs $27,131 [$18,505-$38,185]), and $28,851 ($25,110-$32,548) for those with RSVPO/HO (vs $20,523 [$17,980-$23,222]). The overall RSV-attributable expenditures were $65,230 ($57,167-$73,404), $21,570 ($4,811-$42,337), and $8327 ($5064-$11,535), respectively.

For patients with RSV-LRTI aged 18 to 64 years, the attributable expenditures were:

• $78,820 ($66,559-$90,897) for RSV-LRTI requiring hospitalization;
• $23,111 ($3336-$50,394) for RSV-LRTI requiring PO/HO care, and
• $5738 ($3095-$8526) for RSV-LRTI requiring ED care.

In patients aged 65 years and older, the respective expenditures were $50,037 ($41,441-$59,764), $16,882 ($4571-$35,187), and $18,516 ($7758-$30,420).

Attributable expenditures were generally greater in adults with comorbidities compared with those without comorbidities for all care settings.

Limitations include use of health care claims databases. Additionally, algorithms for identifying RSV-LRTI encounters based on diagnosis codes have not been formally evaluated against a gold standard; a maximum 30-day interval was used for defining RSV-LRTI episodes based on clinical guidance; and RSV-LRTI episodes in this study may not be representative of all patients with RSV-LRTI. Furthermore, adults without health insurance were not included.

“Strategies to prevent RSV-LRTI among adults — including the recent recommendation for RSV vaccination among US adults aged ≥60 years — have the potential to yield considerable economic benefits to the US health care system,” stated the researchers.

Disclosure: The study was sponsored by Pfizer Inc. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Pulmonology Advisor