The clinical and health economic burden of respiratory syncytial virus disease among children under 2 years of age in a defined geographical area

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Abstract
Aims: To describe the clinical and health economic impact of respiratory syncytial virus (RSV) disease in children under 2 years of age. Methods: Hospitalised children less than 2 years of age with a respiratory illness were studied over three consecutive RSV seasons (1996–99). Results: The rates (per 1000 infants under 1 year of age) of hospitalisations from bronchiolitis and RSV illness were 30.8 and 24.4 respectively. The rates of death, intensive care admission, and need for ventilatory assistance during RSV related hospitalisation were 0.2%, 2.7%, and 1.5% respectively. From a cohort of 841 preterm infants, 6.3% had an RSV related hospitalisation during the study period, with the rate rising to 9.2% among those who were either born before 36 weeks gestation and were under 6 months of age at the onset of the RSV seasons, or were less than 2 years of age with chronic lung disease needing home oxygen therapy. Eight of 25 children on home oxygen therapy had RSV related rehospitalisation. Need for assisted ventilation during the neonatal period and discharge home on oxygen therapy were significantly associated with the risk of subsequent RSV related hospitalisation in preterm infants less than 6 months of age. The direct health authority cost of all RSV hospitalisations was £542 203, while the currently recommended immunoprophylaxis for the high risk infants would have cost £652 960. Conclusions: Preterm infants receiving assisted ventilation and those on home oxygen therapy are particularly at risk of RSV related hospitalisation. Serious adverse outcomes are however uncommon even among these high risk infants.