Costs and Complications of Respiratory Syncytial Virus and Acute Respiratory Infections in the Adult Population: Analysis of a German Claims Database

Abstract

Background: Respiratory syncytial virus (RSV) infections pose health and economic burdens to adults. Using claims data, we estimated RSV-associated costs, healthcare resource utilization (HCRU), and complication rates from patients of a nationwide German health insurance database. Methods: We analyzed confirmed RSV, RSV-possible, and acute respiratory infection (ARI) cohorts, plus 1:1 matched control cohorts of individuals ≥ 18 years from 2010 to 2019. Matching was performed separately for patients 18–49, 50–59, and ≥ 60 years. Medical costs, HCRU, and sick leave were assessed for inpatients and outpatients. Complications were compared between cases and controls, and logistic regression assessed odds ratios (ORs) for risk. Results: Altogether, 2668 confirmed RSV index episodes occurred. In ≥ 60-year-olds, 862 episodes incurred mean excess costs of €3773 (95% confidence interval [CI]: €2956–€4591) per episode during the index quarter and €3286 (95% CI: €1841–€4732) in the following four quarters. Mean costs were €5553 per episode for inpatients and €116 for outpatients. In ≥ 60-year-olds, risk for congestive heart failure hospitalization (OR 2.3; 95% CI: 1.4–3.8), exacerbation of asthma (OR 6.0; 95% CI: 1.7–20.9), and chronic obstructive pulmonary disease (OR 3.9; 95% CI: 2.6–5.8) were higher for confirmed RSV than controls. In younger groups, costs, HCRU, and complications were also higher in cases than controls. The complication frequencies increased with age. RSV-possible episodes incurred mean excess costs of €615 (95% CI: €605–€626) during the index quarter and €610 (95% CI: €583–€637) during the following four quarters, while in the ARI cohort, the excess costs were €1003 (95% CI: €991–€1015) during the index quarter and €1003 (95% CI: €973–€1032) in the following four quarters. For all three cohorts, individuals who had comorbidities, were immunocompromised, or living in long-term care facilities incurred higher costs. Conclusions: Confirmed RSV is associated with high excess costs – especially in hospital settings – and HCRU. Complication risk increased with RSV presence.