Management cost of acute respiratory infections in older adults in China: A systematic review and meta-analysis.

Background: Acute respiratory infection (ARI) poses a significant public health challenge worldwide, particularly among older adults. Understanding the cost of ARI management is important for optimising intervention strategy. We aimed to estimate the management cost of ARI in older adults in China. Methods: We searched three English databases (MEDLINE, Embase, and Web of Science) and four Chinese databases (Chinese National Knowledge Infrastructure, Wanfang, SinoMed, and VIP) to identify studies published between 1 January 1995 and 27 February 2023 on the cost of ARI management in older adults in China. We pooled up age group and category-specific costs across individual studies by calculating median and interquartile range (IQR). All cost results were converted and inflated to USD in 2021. Results: We included 99 studies, of which 50 were determined as high quality. In those aged >60 years, the median total cost of ARI, including direct medical, direct non-medical, and indirect cost, was USD 3263 (IQR = 2676-3786) in the inpatient setting and USD 104 (IQR = 80-129) in the outpatient setting. For both inpatient and outpatient settings, direct medical costs accounted for most of the costs (69.3% and 54.8%, respectively). There was an increasing trend over age in the median direct medical cost in the inpatient setting, ranging from USD 1517 (IQR = 1114-2017) in those aged ≥50 years to USD 3493 (IQR = 2608-4378) in those aged ≥80 years. Conclusions: Our study fills the knowledge gap on the cost of ARI and suggests that the overall cost of ARI is substantial among older adults in China. Cost data stratified by region, pathogen, and presence of comorbidities are warranted to help further identify subpopulations with higher ARI management costs. Registration: PROSPERO CRD42023485669.