OBJECTIVES: Respiratory syncytial virus (RSV) infection can lead to hospitalization but relying on RSV diagnosis codes alone for measurement underestimates its impact. The research objective was to estimate the clinical and economic burden of RSV-associated cardiorespiratory hospitalizations among publicly and privately insured adults in the United States (US).

METHODS: A retrospective cohort of adults ≥18 years enrolled in commercial, Medicare Supplemental, or Medicaid benefits in the Merative^TM MarketScan claims database were assessed in September through August of 2017-2018 and 2018-2019. Negative binomial regression models estimated the number of RSV-associated cardiorespiratory hospitalizations using MarketScan-identified cardiorespiratory diagnosis codes in the presence or absence of RSV circulation per weekly laboratory test positivity percentages from the Centers for Disease Control and Prevention. The difference between model estimates in the presence and absence of RSV represents the number of RSV-associated cardiorespiratory hospitalizations. This number was multiplied by mean cardiorespiratory hospitalization costs to calculate annual RSV-associated cardiorespiratory hospitalization costs. The number and cost of ICD-coded RSV hospitalizations were quantified from MarketScan. The percentage of RSV-associated cardiorespiratory hospitalizations divided by MarketScan-identified cardiorespiratory hospitalizations was quantified.

RESULTS: A total of 24,362,080 adults (mean age, 43.9 years; 55.5% female) and 21,359,058 adults (mean age, 43.9 years; 54.9% female) were assessed in 2017-2018 and 2018-2019, respectively. In 2017-2018 and 2018-2019, respectively, 567,352 and 460,386 cardiorespiratory hospitalizations were observed, 51,081 (95% confidence interval [CI], 39,747-65,261) and 32,697 (95% CI, 15,985-45,822) RSV-associated cardiorespiratory hospitalizations were estimated, and 1,843 and 1,597 ICD-10-coded RSV hospitalizations were observed. In 2017-2018 and 2018-2019, respectively, RSV-associated cardiorespiratory hospitalizations comprised 9% and 7% of MarketScan-identified cardiorespiratory hospitalizations. In 2017-2018 and 2018-2019, respectively, RSV-associated cardiorespiratory hospitalizations cost $1,423,453,795 (95% CI, $1,107,613,750-$1,818,602,183) and $800,742,337 (95% CI, $391,469,133-$1,122,170,699), and ICD-10-coded RSV hospitalizations cost $55,032,822 and $41,617,966.

CONCLUSIONS: RSV contributes to substantial clinical and economic burden of cardiorespiratory hospitalizations among US adults.