Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.
Infection. 2024 Oct;52(5):1715-1724. doi: 10.1007/s15010-023-02122-8. Epub 2023 Nov 16.
Clinical and direct medical cost data on RSV-related hospitalizations are relevant for public health decision-making. We analyzed nationwide data on RSV-coded hospitalizations from Germany in different age and risk groups.
Assessment of RSV-coded hospitalizations (ICD-10-GM RSV-code J12.1/J20.5/J21.0 as primary discharge diagnosis) from 01/2010 to 12/2019, using remote data retrieval from the Hospital Statistics Database of the German Federal Statistical Office.
Overall, 205,352 RSV-coded hospitalizations (198,139 children < 18 years, 1,313 adults, 5,900 seniors > 59 years) were reported (median age < 1 year, IQR 0; 1; 56% males, 32% with RSV pneumonia). Annual median RSV-coded hospitalization incidence was 24.8/100,000 persons (IQR 21.3; 27.5); children reported a median incidence of 145.8 (IQR 130.9; 168.3). Between 2010 and 2019, hospitalization incidence increased 1.7-fold/15.1-fold/103-fold in children/adults/seniors. Adults and seniors reported higher rates of underlying chronic conditions, complications, and intensive care treatment than children; of 612 in-hospital fatalities, 103/51/458 occurred in children/adults/seniors. Per-patient mean costs varied between 3286€ ± 4594 in 1-4-year-olds and 7215€ ± 13,564 among adults. Increased costs were associated with immune disorders (2.55-fold increase compared to those without), nervous system disorders (2.66-fold), sepsis (7.27-fold), ARDS (12.85-fold), intensive care (4.60-fold) and ECMO treatment (16.88-fold).
The economic burden of RSV-related hospitalizations in Germany is substantial, even when only considering cases with RSV-coded as the primary discharge diagnosis. Children represented the vast majority of RSV-coded hospitalizations. However, adults and seniors hospitalized for RSV were at a higher risk of severe complications, required more costly treatments, and had higher fatality rates; although their RSV-coded hospitalization incidence showed a clear upward trend since 2017, their true hospitalization incidence is still likely to be underestimated due to lack of routine RSV testing in these age groups. Hence, new treatments and vaccines for RSV ideally should also target adults and seniors in addition to children.
有关 RSV 相关住院的临床和直接医疗成本数据对于公共卫生决策具有重要意义。我们分析了德国不同年龄和风险组中基于 RSV 编码的住院治疗的全国性数据。
评估了 2010 年 1 月至 2019 年 12 月期间基于 RSV 编码的住院治疗（ICD-10-GM RSV 编码 J12.1/J20.5/J21.0 作为主要出院诊断），使用德国联邦统计局医院统计数据库进行远程数据检索。
总体而言，报告了 205352 例基于 RSV 编码的住院治疗（198139 例儿童<18 岁，1313 例成人，5900 例老年人>59 岁）（中位数年龄<1 岁，IQR 0；1；56%为男性，32%为 RSV 肺炎）。每年基于 RSV 编码的住院治疗发生率为 24.8/100000 人（IQR 21.3；27.5）；儿童报告的中位发生率为 145.8（IQR 130.9；168.3）。2010 年至 2019 年期间，儿童/成人/老年人的住院治疗发生率分别增加了 1.7 倍/15.1 倍/103 倍。成人和老年人比儿童报告的基础慢性疾病、并发症和重症监护治疗的比例更高；612 例住院死亡中，103/51/458 例发生在儿童/成人/老年人中。每位患者的平均费用在 1-4 岁儿童为 3286 欧元±4594 欧元，而成年人为 7215 欧元±13564 欧元。费用增加与免疫紊乱（与无免疫紊乱相比增加 2.55 倍）、神经系统疾病（增加 2.66 倍）、败血症（增加 7.27 倍）、ARDS（增加 12.85 倍）、重症监护（增加 4.60 倍）和 ECMO 治疗（增加 16.88 倍）有关。
德国与 RSV 相关的住院治疗的经济负担很大，即使仅考虑以 RSV 编码为主要出院诊断的病例也是如此。儿童占 RSV 编码住院治疗的绝大多数。然而，因 RSV 住院的成年人和老年人患严重并发症的风险更高，需要更昂贵的治疗，死亡率更高；尽管自 2017 年以来，他们的基于 RSV 编码的住院治疗发生率呈明显上升趋势，但由于这些年龄组缺乏常规 RSV 检测，他们的实际住院治疗发生率仍可能被低估。因此，针对 RSV 的新治疗方法和疫苗理想情况下也应针对儿童以外的成年人和老年人。
