Observational studyRespiratory research2026
The outpatient economic burden of respiratory syncytial virus infection in adults aged ≥ 60 years in Germany: results from the BUCOSS study.
Observational study in Respiratory research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRespiratory syncytial virus (RSV) is a major cause of acute respiratory infection (ARI) in adults aged ≥ 60 years, but data on its outpatient epidemiology and societal costs remain limited.
methodsBUCOSS was a prospective observational study conducted over 3 seasons (2022/23-2024/25) in adults aged ≥ 60 years presenting with ARI to 29 outpatient practices in Germany. Multiplex PCR testing was performed at baseline. RSV-positive patients were prospectively followed for up to 28 days. Clinical and socioeconomic burden, including direct medical, indirect, and patient-borne out-of-pocket costs, was assessed using structured questionnaires on days 0, 14, and 28. Approximate national burden was estimated using incidence-based and ARE-prevalence-based extrapolation, including an additional scenario analysis excluding indirect costs.
resultsAmong 3,261 patients with ARI, 192 (5.9%) had PCR-confirmed RSV infection. RSV prevalence was 5.49%, and estimated RSV incidence was 1,030.6 cases per 100,000 population. After exclusion of 4 patients hospitalized at baseline, 188 patients were included in the outpatient cost analysis. Mean age was 71.6 (SD 8.52) years, 57.4% were female, and 60.1% met the study high-risk criteria. Mean societal cost per episode was €510.0 (SD €742.58); costs were highest in patients aged 60-64 years. Total costs comprised direct medical costs of €161.3 (SD €59.57), indirect costs of €331.8 (SD €746.75), and out-of-pocket costs of €16.9 (SD €22.25), corresponding to 31.6%, 65.1%, and 3.3% of total societal costs, respectively. Indirect costs were driven almost entirely by productivity losses. Approximately 40% of cases occurred in adults without study-defined high-risk status. The two extrapolation approaches yielded approximate estimates of 258,000-374,000 medically attended outpatient RSV cases per season among adults aged ≥ 60 years in Germany, corresponding to €131.7-190.9 million in societal costs. In a scenario analysis excluding indirect costs, the estimated burden decreased to €46.0-66.7 million per season.
conclusionsRSV is an economically important cause of outpatient ARI in older adults. These findings highlight a substantial outpatient burden beyond inpatient care and support RSV prevention strategies in aging populations.
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