Estimating the economic burden of respiratory syncytial virus infection among children <2 years old seeking care in North-West Nigeria

BACKGROUND: Respiratory syncytial virus (RSV) disease burden is highest in low- and middle-income countries; yet data for costs of RSV-related illness in these settings are scarce. We estimated RSV costs of illness to inform decision-making for RSV preventive strategies in Nigeria.

METHODS: This prospective study assessed the costs of care per episode of (severe) acute respiratory infection during one RSV season (April to November 2023). Children <2 years old, were recruited at tertiary inpatient and outpatient facilities in North-West Nigeria and grouped as non-severe (outpatient), severe (inpatient non-intensive care), and life-threatened (intensive care or fatality) cases. Direct medical, direct non-medical, and indirect cost data were collected using caregiver questionnaires at the index visit or day of admission and follow-up and gathered from hospital records at discharge. We summarised average costs in 2023 USD.

RESULTS: We included 792 children (mean age 8.7 months) with non-severe (n = 692), severe (n = 52), and life-threatening (n = 48) respiratory infections. Among these groups we confirmed RSV infection in 130 (19%), 19 (37%), and 14 (29%) children. The average societal costs were USD 13 (95% confidence interval (CI) = 11-14), USD 244 (95% CI = 198-290), and USD 179 (95% CI = 120-239) per episode of non-severe, severe, and life-threatening RSV infection, respectively. Costs associated with RSV did not increase stepwise with the severity categories due to small group sizes and fatalities with low costs included in the life-threatened group. For severe RSV, average household costs were over 200% of the national monthly minimum wage. Most households (89%) resorted to personal savings to cover costs.

CONCLUSIONS: In young children in Nigeria, RSV presented a significant health and economic burden. This study can inform health economic evaluations of emerging RSV pharmaceutical interventions for Nigeria and may be adjusted for rural/urban contexts and level of care.