OBJECTIVES: Annually, 3–7% of older adults in the United States (US) experience respiratory syncytial virus (RSV) infection. However, estimating the costs associated with RSV is challenging because of undertesting/underdiagnosis of RSV in clinical practice. The current study estimates RSV-related health care resource use and associated direct medical costs by highest level of care received among adults aged ≥60 years in the US.
METHODS: A retrospective observational study was conducted using administrative health insurance claims data from Optum Clinformatics (July 2016–June 2020). RSV cases were identified using ICD-10-CM diagnosis codes and were classified based on the highest level of care received during the episode (hospitalization, emergency department [ED] visit, or outpatient visit). Incremental all-cause health care costs were calculated over specified follow-up periods for individuals with RSV versus matched controls.
RESULTS: Overall, 12,704 diagnosed RSV episodes were observed during the study period. The incidence rate of medically-attended diagnosed RSV was 0.66 per 1,000 person-years, with rates increasing over the study period. Almost 91% of the episodes were classified as lower respiratory tract disease, and 67.9% of the cases were hospitalized, 13.2% resulted in an ED visit, and 18.9% resulted in an outpatient visit as the highest level of care received. A total of 7.7% of hospitalized RSV patients died within 30 days of the episode index date. Incremental all-cause direct medical costs were $36,121 for hospitalized cases, $7,060 for ED cases, and $331 for outpatient cases at 30 days post-index date for RSV cases versus matched controls.
CONCLUSIONS: RSV testing and reporting in the medical claims database is likely prioritized for severe cases resulting in a low estimated incidence rate. Despite this underreporting, the results of the current study highlight the substantial burden of RSV in adults aged ≥60 years.
