Hospitalizations due to respiratory syncytial virus (RSV) infections in Germany: a nationwide clinical and direct cost data analysis (2010-2019)

<bold>Purpose: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>Overall, 130,084 RSV-coded hospitalizations (123,091 children < 18 years, 1260 adults, 5733 seniors > 59 years) were reported (median age < 1 year, IQR 0; 1; 56% males, 50% with RSV pneumonia). Annual median RSV-coded hospitalization incidence was 15.7/100,000 persons (IQR 13.5; 17.8); children reported a median incidence of 90.9 (IQR 82.5; 101.9). Between 2010 and 2019, hospitalization incidence increased 1.5-fold/4.5-fold/111-fold in children/adults/seniors. Adults and seniors reported higher rates of underlying chronic conditions, complications, and intensive care treatment than children; of 599 in-hospital fatalities, 92/51/456 occurred in children/adults/seniors. Per-patient mean costs varied between 3443<euro> +/- 4924 in 1-4 year-olds and 7339<euro> +/- 13,650 among adults. Increased costs were associated with immune disorders (2.45-fold increase compared to those without), nervous system disorders (2.56-fold), sepsis (6.88-fold), ARDS (11.92-fold), intensive care (4.85-fold), and ECMO treatment (16.08-fold).<bold>Conclusion: </bold>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.