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.