Estimating the economic burden of respiratory syncytial virus infection among children <2 years old receiving care in Maputo, Mozambique.

Background: Data on costs of respiratory syncytial virus (RSV) in low- and lower-middle-income countries are urgently needed to inform the introduction of recently developed vaccines. We estimated the costs of lower respiratory tract infections associated with RSV infection in Mozambique. Methods: We conducted a prospective cohort study to assess household and societal costs of RSV infection in children <2 years old who sought care in a referral hospital or a primary health centre in Mozambique during one local RSV season (February to August 2023). We used molecular point-of-care testing to confirm RSV status. We collected direct medical and non-medical costs and indirect cost data from hospital records and patient-level questionnaires at the initial visit and 2-4 weeks post-discharge. Results: We recruited 544 children; 52.6% were girls and the median age was 9.3 months. From the sample, 286 children from the outpatient department, 233 from the paediatric wards, and 25 from the intensive care unit (ICU). RSV was confirmed in 42 (14.7%) outpatients, 111 (47.6%) inpatients, and 6 (24.0%) ICU cases. The mean total costs associated with RSV were USD 43 (95% confidence interval (CI) = 11-76) for outpatients, USD 612 (95% CI = 544-680) for inpatients, and USD 1161 (95% CI = 837-1485) for ICU cases. The government covered 16.9%, 89.9%, and 80.0% of overall societal costs for outpatients, inpatients, and ICU patients, respectively. The average household out-of-pocket costs for life-threatened RSV cases were more than 1.5 times the monthly minimum wage of USD 91, causing a high financial burden on families in Mozambique. Conclusions: RSV infection represents a significant healthcare and economic burden in children <2 years old. Our results provide input for cost-effectiveness analyses and informed decision-making when considering RSV immunisation in Mozambique.