OBJECTIVES: Respiratory syncytial virus (RSV) is an important cause of acute upper and lower respiratory tract disease in children ≤ 2 years of age. However, little is known about the burden and costs of RSV at that age in Germany ­– a gap that this study aims to address.

METHODS: In this retrospective cohort study, German claims data from the Statutory Health Insurance database ‘German Analysis Database’ were analyzed focusing on the pre-pandemic years 2014-2019. RSV lower respiratory tract illness (LRTI) episodes were determined from patients with either a specific RSV diagnosis (ICD-10-GM: B97.4, J12.1, J20.5, J21.0) year-round and/or an unspecified bronchitis/bronchiolitis/pneumonia (UBP) diagnosis within the RSV season. Clinical burden, 30-days (inpatients) and 1-year (outpatients) all-cause costs (compared to a matched control group) were estimated for infants (0-12 months) and toddlers (13-24 months), stratified by month of life and preterm status.

RESULTS: A major proportion of RSV LRTI episodes occurred in the hospital sector (infants: 64%, toddlers: 42%), though outpatient numbers are likely underreported. Within the first year of life, 43% of hospitalizations were observed in the first three months, and 74% within the first 6 months of life. Of note, 87% of hospitalized infants were born at term. Excess costs of RSV were found higher in inpatients (infants: 3,534 €, toddlers: 3,372 €) than outpatients (infants: 148 €, toddlers: 179 €), even higher for hospitalized infants ≤ 3 months of age (4,012 €) and highest for those born preterm (5,392 €).

CONCLUSIONS: RSV constitutes a large clinical and economic burden on the German health care system, especially during the first months of life. While the burden of hospitalization is high, the outpatient burden should not be underestimated. These findings also emphasize the importance of broader surveillance to identify the most vulnerable groups and to consequently implement preventive measures such as immunizations.