Assessing the cost of illness of RSV and non-RSV acute respiratory infections in Nepali children.

Low- and middle-income countries (LMICs) bear the greatest burden of the global respiratory syncytial virus (RSV) morbidity and mortality, but lack cost data to evaluate the health-economic impact of RSV burden on families, the healthcare system, and society. This prospective observational study was performed by the RSV GOLD III - Health Economic Research Group and estimated the costs associated with RSV illness in Nepal. We collected healthcare resource utilisation data from children <2 years old fulfilling the World Health Organization (severe) acute respiratory infections ((S)ARI) case definition over one local respiratory season (July to November 2023) at two public hospitals in Nepal. We used hospital records and caregiver interviews to collect direct medical, direct non-medical, and indirect cost data to generate total per-patient costs. We included 730 patients with a mean age of 6.8 (standard deviation = 5.8) months. RSV infection was confirmed in 72.6% of the inpatients (n/N = 469/646) with SARI. The mean total cost per RSV episode was USD 43 (95% confidence interval (CI) = 25-62) for non-severe, USD 312 (95% CI = 293-332) for severe, and USD 664 (95% CI = 381-947) for life-threatened patients. Of the total costs, the healthcare system incurred USD 16 (36.3%), USD 58 (18.6%), and USD 57 (8.6%) in each category of illness. Household-level costs were 1.4% (USD 19) of the country's gross domestic product per capita for non-severe, 15.1% (USD 200) for severe, and 35.7% (USD 472) for life-threatened patients, with costs for inpatients often reaching catastrophic levels. Our findings show a significant healthcare and economic burden of RSV illness in Nepal, highlighting the need to prioritise RSV prevention strategies. Our cost burden data can inform the modelling of costs and benefits of future RSV interventions in Nepal.