OBJECTIVES: This systematic literature review and synthesis sought to critically assess evidence on the cost per medically-attended episode of RSV illness in infants 0–11 months and children 0-59 months of age in the United States.

METHODS: We searched PubMed and 9 other databases (PROSPERO CRD42020168469) and identified studies in English published 1/1/2014-2/8/2020 which reported RSV-related costs in US children 0-59 months of age. We assessed bias and extracted costs by setting, gestational age at birth, chronological age group, and payer type. The weighted analysis adjusted costs to January 2020 US$, removed overlaps, and weighted by the national gestational age distribution.

RESULTS: We included 17 eligible studies. Of these, 13 reported on inpatient medical costs (5 on full-term infants), 4 on outpatient medical costs, and none on indirect costs. RSV hospitalization costs increased with declining gestational age at birth. Costs of extremely preterm infants averaged 5 times those of full-term infants. Weighted all-payer hospitalization costs averaged (95%CI) $11,973 ($11,577-$12,369) for infants and $12,315 ($11,905-$12,725) for children aged 0-59 months. Full-term infants accounted for 82% of all infant RSV hospitalizations and 70% of aggregate RSV inpatient hospitalization costs. Medicaid payments per RSV hospitalization averaged 32% below those of commercial insurers (weighted means [95%CI] $10,394 [$9,869-$10,918] and $15,289 [$14,491-$16,086], respectively). While Medicaid covered 46% of all births, it financed 61% of RSV infant hospitalizations and 51% of RSV infant hospitalization costs. Medicaid-insured infants were 84% (OR=1.84) more likely than non-Medicaid infants to be hospitalized for RSV.

CONCLUSIONS: This weighted analysis of costs per RSV hospitalization provides nationally representative averages and aggregates. Despite extremely preterm infants having the highest average costs per episode, full-term infants are the main source of RSV hospitalizations and costs. Medicaid pays for about half of infant RSV hospitalizations and 61% of RSV infant hospitalization costs.