Health care costs of hospitalization of young children for respiratory syncytial virus infections: a population-based matched cohort study

Nisha Thampi; Braden D. Knight; Kednapa Thavorn; Richard J. Webster; Krista Lanctot; Steven Hawken; J. Dayre McNally

doi:10.9778/cmajo.20200219

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Figure 1:
Identification of patients hospitalized with respiratory syncytial virus (RSV) and controls. Patients were matched with up to 5 controls, where possible. Ideally, 5 matches were found per case; in the event of fewer matches, a lower matching ratio was permitted.
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Figure 2:
Frequency of cost per individual, compared between patients hospitalized with respiratory syncytial virus (RSV) and controls. Costs are represented on a logarithmic scale (2020 Canadian dollars).
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Figure 3:
Cost over time between patients hospitalized with respiratory syncytial virus (RSV) and controls (2020 Canadian dollars). (A) Monthly mean costs per patient compared with control after discharge. (B) Monthly mean cost differences after discharge between patients and controls, stratified by cost component. Note: NACRS = National Ambulatory Care Reporting System, OHIP = Ontario Health Insurance Plan. “Other” costs include those attributed to the Ontario Drug Benefit, complex & continuing care, home care, capitation for family health organizations or networks and the Assistive Devices Program.

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Table 1:

Administrative health databases with routinely collected information on health care resource utilization

Category	Database
Care providers	ICES Physician Database
Coding and geography	Drug Identification Numbers
	Local Health Integration Network
	Postal Code Conversion File
Facilities	Institutions funded by the Ministry of Health
Financial	Average Price of Health Services
Financial	Estimated Schedule of Benefits
Health services	Continuing Care Reporting System
	Discharge Abstract Database
	Home Care Database
	National Ambulatory Care Reporting System
	National Rehabilitation Reporting System
	Ontario Drug Benefit Claims
	Ontario Health Insurance Plan
	Ontario Mental Health Reporting System
	Same Day Surgery

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Table 2:

Attributable mean 12-month cost per patient or control, stratified by risk factor and age at index date^*^†

Variable	No. of participants		Mean cost ± SD, $		Median cost (IQR), $		Adjusted mean cost difference between patients and controls, $ (95% CI)

	Patients with RSV	Controls	Patients with RSV	Controls	Patients with RSV	Controls
All	14608	72040	12 080 ± 28 229	2410 ± 16 305	6760 (5610–9890)	590 (340–1140)	9240 (8790–9690)

CHD	719	1930	40 490 ± 82 500	22 730 ± 61 416	13 230 (7860–30 730)	2920 (1100–11 900)	24 130 (10 780–38 760)

Hemodynamically significant CHD	45	67	102 540 ± 102 996	41 540 ± 56 632	68 090 (24 580–139 330)	19 750 (3000–49 220)	60 110 (26 700–93 060)

Nonhemodynamically significant CHD	674	1863	36 350 ± 79 329	22 050 ± 61 488	12 190 (7550–26 720)	2800 (1060–10 960)	17 460 (2960–34 020)

CLD	122	427	35 420 ± 78 798	10 030 ± 32 883	11 730 (8510–21 510)	2600 (1280–6120)	22 140 (10 420–39 550)

Gestational age, wk

22–28	191	723	31 500 ± 59 582	17 570 ± 51 223	11 200 (7970–23 590)	2450 (1070–6380)	10 860 (880–20 660)

29–32	292	1339	27 220 ± 51 452	9790 ± 25 503	9710 (6520–19 670)	1640 (790–5170)	16 510 (10 070–24 290)

33–35	909	4421	16 050 ± 42 434	4430 ± 26 465	7710 (5910–12 350)	810 (400–1920)	11 220 (8730–14 550)

36–43	13216	65557	11 190 ± 24 682	1950 ± 14 093	6640 (5580–9500)	540 (320–1010)	8920 (8500–9360)

Premature	1392	6483	20 510 ± 50 022	7000 ± 30 375	8430 (6160–14 510)	1070 (500–2950)	12 280 (9450–15 230)

No comorbidities and full-term birth			10 200 ± 20 273	1590 ± 11 301	6570 (5550–9210)	560 (330–1030)	8170 (7830–8500)

Age at index hospitalization, mo

< 2	4566	19500	13 670 ± 32 168	3550 ± 19 049	7160 (5860–11 390)	680 (400–1320)	10 710 (9880–11 530)

2–3	3068	14525	10 350 ± 24 692	2390 ± 20 908	6380 (5530–8910)	590 (350–1120)	7780 (6840–8770)

4–5	1752	10209	11 240 ± 23 570	2100 ± 14 845	6530 (5520–9410)	570 (330–1110)	8270 (6980–9460)

6–11	2616	12531	11 770 ± 25 438	1890 ± 12 996	6820 (5650–9780)	590 (330–1130)	9070 (8160–10 020)

12–23	2606	15275	12 200 ± 30 100	1610 ± 9306	6660 (5390–9480)	490 (260–990)	8690 (7460–9910)

Note: CHD = congenital heart disease, CI = confidence interval, CLD = congenital lung disease, IQR = interquartile range, RSV = respiratory syncytial virus, SD = standard deviation.
↵* Cost adjusted to 2020 Canadian dollars, rounded to the nearest tens digit, and adjusted for covariates using the propensity score.
↵† Index dates for patients were admission dates for their first RSV hospitalization. Index dates for controls were randomly generated based on the distribution of index dates among patients with RSV.