OBJECTIVES

: To examine hospital utilization for elderly patients diagnosed with respiratory syncytial virus (RSV) compared to influenza.

METHODS

: A retrospective matched cohort was conducted on a cross-section of hospital discharges with any ICD-10-CM diagnosis of RSV (n=13,841) or influenza (n=92,770) using the 2016-2018 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Cohorts were matched (n=13,841) on discharge year, quarter, and gender with additional propensity score matching for age, race, Charlson Comorbidity Index (CCI), hospital location, and teaching status. Logistic regression was used to evaluate in-hospital mortality, hypoxemia, respiratory failure, and mechanical ventilation. General linear models with negative binomial and gamma distributions were used for length of stay (LOS) and charges. Covariates included patient demographics, comorbidities, and hospital characteristics.

RESULTS

: RSV patients were more likely to be female (60.6% vs 44.1%, p<.001) and had higher CCI scores (3.0 vs 2.6, p<.001). Congestive heart failure (41.1% vs 31.3%) and chronic pulmonary disease (56.2% vs 44.7%) were more prevalent (p<.001) in RSV patients as were concomitant diagnoses of bronchitis (29.0% vs 9.7%), bronchiolitis (13.1% vs 0.2%), and pneumonia (22.2% vs 17.8%). RSV patients had higher rates of in-hospital mortality (5.1% vs 4.3%, p<.001), hypoxemia (8.5% vs 8.0%, p<.05), respiratory failure (50.3% vs 37.4%, p<.001), and mechanical ventilation (9.8% vs 6.0%, p<.001) than influenza patients with longer average LOS (6.6 vs 5.6, p<.001) and higher median charges ($27,757 vs $22,164, p<.001).

Matched cohort regression analyses revealed RSV to be significantly associated with in-hospital mortality (OR=1.28, CI=1.14-1.45), hypoxemia (OR=1.14, CI=1.04-1.26), respiratory failure (OR=1.44, CI=1.36-1.52), and mechanical ventilation (OR=1.45, CI=1.31-1.59). Additionally, RSV was associated with approximately 10% increase in LOS (IRR=1.10, p<.001) and hospital charges (IRR=1.11, p<.001).

CONCLUSIONS

: RSV is a significant driver of hospital utilization relative to influenza, indicating a significant unmet need for new viral therapies.