Abstract
Objective: To determine the impact of respiratory syncytial virus (RSV) infection on healthcare resource use and costs in the US from the third-party payer perspective.
Design: The study retrospectively analysed cross-sectional medical encounter data from three federally funded databases that comprise nationally representative samples of hospital inpatient stays, physician office visits and visits to hospital outpatient departments and emergency rooms.
Methods: Identification of RSV infection-related medical encounters was based on the occurrence of RSV-specific International Classification of Diseases (9th Edition)-Clinical Modification diagnosis codes (079.6, 466.11, 480.1) as principal discharge diagnoses or the assumption that 10–15% of all otitis media visits were due to RSV infection. Outpatient drug costs were estimated based on average wholesale price, and physician fees and test/procedure costs were estimated based on prevailing national fees. Inpatient costs were estimated from total billed charges using a cost-to-charge ratio of 0.53.
Results: In 2000, nearly 98% of RSV infection-related hospitalisations occurred in children <5 years old. There were approximately 86 000 hospitalisations, 1.7 million office visits, 402 000 emergency room visits and 236 000 hospital outpatient visits for children <5 years old that were attributable to RSV infection. Total annual direct medical costs for all RSV infection-related hospitalisations ($US394 million) and other medical encounters ($US258 million) for children <5 years old were estimated at $US652 million in 2000. Otitis media was a major cost driver for physician visits. RSV infection-related hospitalisations increased from 1993 to 2000, but average costs per hospitalisation were relatively stable.
Conclusion: Treatment of RSV infection-related illness represents a significant healthcare burden in the US. The economic impact of ambulatory care for RSV infection-related illness could be as important as that for RSV infection-related hospitalisation.
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Notes
The code 466.11 was not available prior to 1996. Estimates based on ICD-9-CM code 466.1 (acute bronchiolitis) for years 1993–1995, with adjustment to reflect the proportion of hospitalisations in the period 1996–2000 that had a code of 466.11 (versus 466.19).
The documentation for the NAMCS and NHAMCS states that estimates of visit characteristics (e.g. age, gender, types of drugs prescribed) based on a sample size of <30 visit records are not reliable. Given that the number of visit records in each database with RSV infection-specific diagnoses (i.e. 079.6, 466.11, 4801.) was <30, RSV infection-related costs were estimated based on resource use obtained from records with a diagnosis of 466.1 (acute bronchiolitis). It was assumed that visits with this diagnosis would have similar resource use patterns compared with the visits that recorded RSV-infection specific diagnoses.
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Acknowledgements
Larry Liu is now employed at Pfizer.
This work was funded by Wyeth Research. The authors have no conflicts of interest that are directly relevant to the content of this study.
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Paramore, L.C., Ciuryla, V., Ciesla, G. et al. Economic Impact of Respiratory Syncytial Virus-Related Illness in the US. PharmacoEconomics 22, 275–284 (2004). https://doi.org/10.2165/00019053-200422050-00001
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DOI: https://doi.org/10.2165/00019053-200422050-00001