Economic impact of RSV infections in young children attending primary care: a prospective cohort study in five European countries, 2021 to 2023

Background: Data on economic costs of respiratory syncytial virus (RSV) infections among children in primary care are scarce, although most RSV-infections are managed in this setting. Aim: To estimate outpatient costs for RSV-positive childrenaged <5 years.Methods: In the RSV ComNet prospective cohort, children<5 years with acute respiratory infection were recruited for RSV testing through primary care physicians in Belgium, Italy, the Netherlands, Spain and the United Kingdom (UK) during RSV seasons 2020/21 (UK only), 2021/22 and 2022/23. Outpatient healthcare utilisation and parental work absence were assessed over 30 days through parental questionnaires. Average costs per RSV episode were calculated from outpatient healthcare sector and societal perspectives, stratified by country and age. Results: We included 3,414 children and 1,124 (33%) tested RSV-positive. Physicians completed reports for 878 episodes, with follow-up questionnaire data for 819 (93%). Outpatient costs ranged from EUR 97 (95% CI: 91–104) in the Netherlands to EUR 300 (95% CI: 287–312) in Spain and were higher for infants than children aged 1–5 years. Societal costs ranged from EUR 454 (95% CI: 418–494) in the UK to EUR 994 (95% CI: 938–1,053) in Belgium. For children aged 1–5 years, societal costs were primarily driven by parental work absence. In infants, the main societal cost driver varied by country, but overall outpatient healthcare costs represented a higher proportion of societal costs vs older children. Conclusion: RSV infections in children attending primary care result in substantial economic costs per episode, although differences exist across countries. This study provides essential data to inform cost-effectiveness analyses on novel RSV immunisations.