Healthcare Resource Utilization and Direct Medical Costs of RSV Infection in Children Under Five Years in Saudi Arabia

INTRODUCTION

• RSV, a major pediatric healthcare burden globally and in Saudi Arabia, accounts for >60% of acute respiratory infections in young children and >80% in infants <1 year of age worldwide, with 15%-50% of LRTI infections in infants attributed to RSV.^1,2
• While regional RSV data remains scarce, MENA region has reported a higher RSV prevalence (24.4% vs. 22% globally) with cases predominantly occurring in winter and disproportionately affecting infants under one year of age.3
• This underscores the urgent need for updated epidemiological data to inform effective prevention strategies in Saudi Arabia.

OBJECTIVE

This study aims to assess the clinical and healthcare burden attributable to laboratory-confirmed RSV cases among children <5 years old in Saudi Arabia, with particular focus on infants aged 0–11 months.

METHODS

Study Design And Setting

• This descriptive, observational study conducted across 5 MNGHA facilities in Saudi Arabia: Riyadh (576 beds), Jeddah (170 beds), Al-Ahsa (67 beds), Al-Madinah (65 beds), and Dammam (34 beds), along with 71 affiliated PCCs.

Study population

• Children ≤5 years with  laboratory-confirmed RSV infection (January 2018–December 2023) were included in the study. Inclusion criteria: confirmed RSV diagnosis, hospitalization or primary care admission. Exclusion criteria: incomplete medical records, RSV co-infection with Flu/Covid-19 or patients transferred from other facilities

Data source and endpoints

• Data was collected from the MNGHA BESTCare^® database.
• Direct medical costs were estimated from the provider perspective and included inpatient ward and ICU admissions, emergency and outpatient visits, diagnostics, and treatments
• Age-stratified cost patterns and annual expenditure trends were assessed.
• To assess comparability with global data, a PubMed search identified studies published between 2020 and 2025 reporting RSV healthcare costs in pediatric populations.
• All cost were reported in SAR. Local costs reported in the published studies were converted into SAR for comparison

Statistical analysis

Descriptive statistics

RESULTS

• Out of 44,632 children with ARI symptoms, 34,957 (78.3%) children were tested and 7,371 (21.09%) of those tested were RSV-positive (median age 10 months; IQR 3.5–23.5). (Figure 1)
• Of these 7,371 infants, those <12 months of age accounted 55% of cases (36.6% in those <6 months).

Figure 1: Number of laboratory-confirmed RSV cases across different age groups. (N =7,371)

^*Percentages are rounded off to their nearest values. IQR: Interquartile Range; n: Number; RSV: Respiratory Syncytial Virus

Table 1: Estimated direct medical cost (SAR) distributed by age and year at diagnosis

Direct Medical Costs of RSV by Season and Age Group

• The highest direct medical cost was observed among infants aged 1–2 months (SAR 4.6 million). Average cost per case was highest in infants <1 month (SAR 4,493.83) and decreased with age, reaching SAR 2,533.36 among children aged 18–23 months. (Table 1)
• Inpatient ward admissions constituted the main cost component, with ICU utilization substantially increased during periods of high case volume. (Table 1)
• Total annual direct medical costs varied across seasons, peaking in 2022 at SAR 13.2 million before declining to SAR 3.5 million in 2023. (Table 1)

Figure 2: Cross-country direct medical cost comparison from globally published studies. All costs are expressed in SAR^*

^*Exchange rate applied is: 1 SAR = 0.23 EUR = 3.55 RUB = 0.27 CNY = 0.27 THB = 0.27 ARS = 0.27 ZAR = 0.27 VND; Costs are average total costs per case/episode in infants <1 year

CONCLUSIONS

• RSV imposes considerable direct medical costs on the Saudi Arabia healthcare system, with annual costs reaching SAR 13.2 million at peak seasons, predominantly driven by inpatient care requirements in young infants.
• These findings are consistent with the substantial economic burden documented in international studies.
• Healthy infants under 1 year of age represent the largest group requiring RSV-associated hospitalization, with the highest per-case costs observed in infants <1 month (SAR 4,493.83), highlighting this population's vulnerability and resource intensity.