# Management cost of respiratory syncytial virus-associated hospitalisation episodes in children: a retrospective analysis of a regionally representative medical database in Eastern China

## TL;DR

This study estimates the hospitalization costs of respiratory syncytial virus in children in China, highlighting high expenses for infants and those with health issues.

## Contribution

The study provides the first detailed economic analysis of RSV hospitalization costs in China using a large regional medical database.

## Key findings

- RSV hospitalization costs averaged USD 645 per episode, with infants and those with comorbidities facing higher costs.
- Diagnosis costs made up the largest portion of total hospitalization expenses.
- Younger age, comorbidities, and hospital type were significant factors influencing medical costs.

## Abstract

Respiratory syncytial virus (RSV) poses a substantial economic burden globally in young children. However, data on the economic burden of RSV are limited in low- and middle-income countries, including China. We aim to estimate the management cost of RSV-associated hospitalisations among children in China.

We conducted a retrospective analysis of a regional medical database covering over 200 hospitals in Jiangsu Province, China, from 1 January 2019 to 31 May 2024. We identified RSV-associated episodes using International Classification of Diseases 10th revision codes and laboratory testing results. We reported the median (MD) and interquartile range (IQR) of direct and out-of-pocket costs per episode and analysed cost-influencing factors using multivariate linear regression.

The sample comprised 14 558 RSV-associated hospitalisation episodes, with the average length of stay being six days (IQR = 5–7). The average direct medical cost was USD 645 (IQR = 504–864), of which 57% (IQR = 32–76) were out-of-pocket; the highest costs were observed in infants aged <1 year (MD = USD 695; IQR = 519–933). Costs varied significantly by hospital type, with Grade III speciality hospitals having higher average costs (MD = USD 876; IQR = 705–1037). Diagnosis cost accounted for the largest proportion of the total cost (MD = 41%; IQR = 32–50), followed by medicine cost (MD = 31%; IQR = 22–41). The cost for patients with comorbidities (MD = USD 826) was 28.5% higher than that for those without comorbidities (MD = USD 643). Multivariate regression analysis revealed that younger age, comorbidities, longer length of stay, higher gross domestic product per capita in the municipality, and Grade III speciality hospitals were associated with higher direct medical costs.

We found that RSV-associated hospitalisation costs in children are substantial in China, particularly among younger children and those with comorbidities. These findings provide critical evidence to inform RSV immunisation strategies and health-economic evaluations.