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Healthcare resource utilisation and costs in infants with confirmed respiratory syncytial virus infections: a national population cohort study

Abstract

Background

Respiratory syncytial virus (RSV) is the leading cause of severe respiratory infections in infants worldwide, significantly affecting their health and contributing to the global healthcare burden. We aimed to examine healthcare resource utilisation patterns and costs for infants under one year old with confirmed RSV infection across subgroups of different gestational ages and health conditions and the cost implications of RSV infections over time, thereby demonstrating the economic burden of the disease.

Methods

This retrospective cohort study utilised nationwide claims data from the Korea Health Insurance Review and Assessment Service for infants under one year of age with confirmed RSV infection in the first year of life from January 2017 to April 2022. The infants were stratified into three subgroups based on their gestational age and health status: unhealthy preterm, healthy preterm, and full-term infants. A descriptive analysis was conducted to estimate healthcare utilization by type of resource and costs related to the treatment of RSV.

Results

Out of 93,585 RSV infections identified, 31,206 patients met the inclusion criteria; these included 963 unhealthy preterm, 1,768 healthy preterm and 28,475 full-term infants. In our study, 76.3% of the infants with confirmed RSV infection required intensive care, including hospitalisation and more critical interventions such as intensive care unit (ICU) or mechanical ventilation (MV). The total average cost of RSV management was notably higher for unhealthy preterm infants ($ 6,325; 95% confidence interval (CI): $ 5,484-7,165) than for healthy preterm ($ 1,134; 95% CI: $ 1,006 − 1,261) and full-term infants ($ 606; 95% CI: 583–630). Our findings confirmed a significant epidemiological and economic burden, with infants at greater risk–shorter gestational age and poorer health conditions. Furthermore, we observed a marked increase in the total average cost of RSV management during COVID-19, reflecting the complex interplay between RSV and pandemic-related healthcare dynamics.

Conclusion

Our findings provide evidence for the significant economic burden of RSV infection among infants, with considerable disparities based on gestational age and health status subgroups. However, RSV prevention policies should also recognise that healthy preterm or full-term infants who receive intensive care face a significant disease burden.

Peer Review reports

Background

Respiratory syncytial virus (RSV) is the leading cause of severe acute respiratory tract infections in infants worldwide, resulting in significant mortality, morbidity, and extensive healthcare utilisation [1]. Healthcare resources for RSV management vary depending on the infants’ gestational age and health conditions [2, 3]. RSV is a significant cause of hospitalisation in infants under one year, accounting for 19–27% of annual hospitalisations, often requiring intensive treatment such as intensive care unit (ICU) admission and mechanical ventilation (MV) [1, 4, 5].

The severity or mortality of RSV infection is even higher in preterm infants and infants with high RSV risk. Young age, prematurity, birth during the first half of the RSV season, the presence of older siblings, and underlying conditions such as chronic lung disease, congenital heart defects, specific genetic abnormalities, or immunodeficiency are well-known risk factors for both RSV infection and its severity [6,7,8]. These conditions worsen RSV-related symptoms or complications, such as asthma and wheezing, bronchitis, pneumonia, and respiratory failure in preterm infants or infants with specific situations, and can even cause death [9,10,11,12]. Consequently, preterm infants are more likely to experience a severe RSV episode, incurring higher healthcare resource use (HRU) and costs [4, 13, 14].

While existing studies have examined healthcare utilisation diversity and treatment costs of RSV in children using health claims data, comprehensive research encompassing the national population focusing on infants under one year, the age group most vulnerable to RSV, is insufficient [15,16,17,18,19]. Moreover, few studies have specifically targeted patients with confirmed RSV infections, and no recent studies have investigated healthcare resource utilisation in this specific population [15,16,17].

Furthermore, notable RSV incidence and seasonality shifts during the COVID-19 period have highlighted the importance of investigating the disease burden amid evolving epidemiological dynamics. Coinfection with RSV and COVID-19 may exacerbate disease severity, particularly among high-risk groups with both respiratory illnesses [18,19,20,21]. Hence, there is a need to investigate the disease burden per patient during the COVID-19 period compared with the pre-COVID-19 period.

Our study aimed to examine healthcare resource utilisation among infants with confirmed RSV infection in Korea, focusing on variations across different birth and health condition subgroups. In addition, we evaluated the cost implications of RSV infection within these subgroups over time to demonstrate the economic burden of the disease, particularly before and during the COVID-19 period.

Methods

Study design and data source

This study employed a retrospective cohort design and used data from the Korea Health Insurance Review and Assessment Service (HIRA) to provide a highly accurate overview of treatments in the Korean healthcare system. The HIRA covers 97% of South Koreans under national health insurance, offering a detailed view of the patient population. The data included inpatient and outpatient medical and pharmacy claims over multiple years, which allowed us to form a longitudinal cohort and enhance the representativeness and robustness of the study [22, 23]. For data cleaning and screening, we reviewed missing data and ensured logical consistency. We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to maintain the accuracy and completeness of the research [24]. The study design, definitions, and diagnosis codes were reviewed and decided upon based on a consensus among three paediatric infectious diseases specialists for clinical plausibility. We examined RSV patient records from January 2017 to April 2022, and our study period was from January 2017 to April 2021 to guarantee a 12-month follow-up for the last patient included. Further details of the study design and cohort index scheme are provided in Supplementary Fig. 1.

Patient selection and subgroup assignment

The study population included all infants under one year old with confirmed RSV infection according to their health insurance claims between January 2017 and April 2021 (data accessed on 24 June 2023). Infants with confirmed RSV infection were identified using the International Classification of Diseases, 10th Revision (ICD-10) codes (J210, J205, J121, and B974) and their ages at RSV diagnosis. The index date was the first RSV diagnosis within the first year of life. Eligible patients had no records of death or censored claims before the 12-month follow-up period. The exclusion criteria were a follow-up period of less than 12 months or a history of RSV infection before the index date. The cohort was followed until the last health insurance claim with RSV diagnosis code during the follow-up period.

We divided these patients into three subgroups unhealthy preterm, healthy preterm, and full-term infants with RSV infection. Preterm birth status was identified using ICD-10 codes for varying degrees of prematurity and specific ICD-10 codes for prematurity and low birth weight (P0720–P0725, P0730, P0731, P0739, P0700, P0701, P0702, P0709, P0710, P0711, P0712, P0713, P0714, and P0719) [25]. Unhealthy preterm infants were defined as high-risk RSV patients with a premature diagnosis and a history of at least one dose of palivizumab. Palivizumab, a humanised monoclonal antibody, is currently the standard of care for RSV prophylaxis in children with high RSV risk [26] and reimbursed under Korea’s national health insurance system: infants with underlying health conditions such as bronchopulmonary dysplasia requiring treatment before six months of age, and those with significant congenital heart disease or so. Most of these infants are unhealthy and defining them solely based on cross-sectional diagnosis identification does not accurately align with the reimbursement criteria for palivizumab in Korea. Unhealthy preterm infants were identified based on criteria for palivizumab coverage in Korea. We consulted with paediatric specialists to validate and ensure the clinical relevance of this criterion for identifying unhealthy preterm infants at higher risk of RSV infection, and the paediatric specialists agreed that this criterion reasonably identifies more vulnerable infants among preterm infants.

Measuring study outcomes

Study outcomes and HRU definitions

The study’s primary outcomes were the proportion of RSV-related HRU and the treatment costs for infants under one year. We calculated the RSV-related HRU as the proportion of healthcare services used for RSV in the first year of life divided by the total number of confirmed RSV patients. Our analysis included all healthcare resources within 12 months of the initial RSV diagnosis. An HRU was considered RSV-related if the healthcare claim was linked to an RSV diagnosis, with each service per patient counted as a distinct HRU. The healthcare services of interest included outpatient visits, emergency room (ER) visits, hospital admissions, intensive care unit (ICU) admissions, and mechanical ventilation (MV) use. The HRUs were defined based on a hierarchical approach, considering the intensity of healthcare resource utilisation and mutually exclusive. In our hierarchical classification, patients who were hospitalized and admitted to ICU were classified as ICU admission; those who also received mechanical ventilation were further classified as MV use. Supplementary Fig. 2 provides more details on the healthcare resource user definition. The results of analysis were reviewed and confirmed with paediatric infectious disease specialists regarding their clinical plausibility and reliability in the context of Korea.

RSV-related healthcare resource utilization and costs

We analysed the proportion of RSV-related HRU and treatment costs for unhealthy, healthy, and full-term infants and the average RSV-related treatment costs per patient. We estimated the average RSV-related treatment costs of each HRU type (outpatient, inpatient, ICU, ER, and MV) users by summing all RSV-related expenses for a year and dividing them by the number of patients. We also calculated RSV-related treatment costs by gestational age groups of infants: ≤27 wGA, 28–31 wGA, 32–36 wGA, unspecified wGA, and full-term.

RSV-related healthcare resource utilization and costs

RSV-related treatment cost trends were examined before and after the COVID-19 period: January 2017 to December 2019 was the pre-COVID-19 period, and January 2020 to April 2021 was the COVID-19 period. All costs were calculated in 2023 US dollars (USD) at an exchange rate of 1,307.76 Korean won (KRW) to 1 US dollar (USD), reflecting the annual average exchange rate for 2023.

Statistical analysis

We performed descriptive statistics to determine the baseline characteristics and outcomes of the study population. Continuous variables were reported as averages and standard deviations, while categorical variables were presented as counts and percentages. Health resource utilisation rates for each resource user group were estimated as frequencies and rates. The 95% confidence interval (CI) and a predefined significance level of 0.05 were used in the analysis to define the significance of the difference. Costs were presented in US dollars, and the outcomes were average, median, interquartile range (IQRs), and 95% CIs. Statistical analyses were performed using the SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA).

Results

Study population baseline characteristics

We identified 93,585 infants with confirmed RSV infection in the first year of life, of whom 31,206 met our inclusion criteria during the study period and the study population selection flow is described in Supplementary Fig. 3. Within this group, 963 (3.1%) were classified as unhealthy preterm, 1,768 (5.7%) as healthy preterm, and the remaining 28,475 (91.3%) as full-term infants.

Table 1 shows the demographic characteristics of the patients diagnosed with their first RSV infection. Overall, 58.0% of the infants with RSV infection were male. Regarding gestational age, 17.5% of unhealthy preterm infants and 1.6% of healthy preterm infants were under 27 weeks of gestational age (wGA); 30.7% of unhealthy preterm infants and 2.7% of healthy preterm infants were between 28 and 31 wGA; and compared to 71.1% of healthy preterm infants, 40.9% of unhealthy preterm were between 32 and 36 wGA. Within the study population, 28,533 infants were diagnosed with their first RSV infection before COVID-19. The annual distributions of the first RSV diagnoses were 28.8%, 31.5%, and 36.8% in 2017, 32.1%, 31.6%, and 30.6% in 2018, and 23.3%, 25.7%, and 24.4% in 2019 for unhealthy preterm, healthy preterm, and full-term infants, respectively.

Table 1 Baseline characteristics of the study population by subgroup

RSV-related healthcare resource utilisation

Figure 1 displays the distribution of RSV-related HR during the one-year follow-up period following the first RSV infection in infants. Among the total population of RSV-infected infants, 76.3% required substantial medical care, 70.6% were hospitalised, 4.3% received ICU care, and 1.4% required MV. Furthermore, 23.1% of the patients only utilised outpatient services, while only 0.6% required ER visits or outpatient services, representing the lowest proportion of HRU.

A detailed comparison of HRU among different subgroups revealed significant variability in using each type of health resource (p < 0.0001). Hospitalisation remained the most commonly used health resource across all subgroups. Notably, ICU and MV were most frequently required by unhealthy preterm infants, with 19.5% requiring ICU admission and 15.2% requiring MV, indicating that a higher intensity of care is needed for this particularly vulnerable subgroup.

RSV-related treatment costs by subgroup

We analyzed the average RSV-related healthcare costs per patient based on the type of resource utilization, revealing significant cost disparities among different patient groups (Table 2). Significant differences in average RSV-related healthcare costs were observed in patients utilizing outpatient services only but not for ER user groups. There was no significant difference in average RSV-related healthcare costs between the healthy preterm and full-term groups for hospitalization, ICU, and MV users. However, there was a statistically significant cost difference between these two groups and the unhealthy preterm group.

The overall population’s average RSV-related treatment cost per patient was $818 (95% CI: $782–$854). The average RSV-related treatment cost per patient varied significantly depending on the type of care required; for patients receiving only outpatient care, the cost was the lowest at $61 (95% CI: $58–$64), whereas for those requiring MV, the cost surged to $23,144 (95% CI: $20,559–$25,730).

In a detailed subgroup analysis, unhealthy preterm infants who required MV incurred the highest average RSV-related costs per patient, amounting to $39,832 (95% CI: $34,872–$44,792). This figure is notably more than 800 times greater than the average RSV-related treatment cost per patient for full-term infants who only required outpatient visits, which were the lowest at $46 per patient (95% CI: $44-$48). This result contrasts with the significant financial burden associated with the intensive care of the most vulnerable infants. However, patients utilised ICU or MV at each subgroup, the average RSCV-related treatment cost per patient.

Table 2 The average RSV-related treatment cost per patient within one year after first RSV infection (unit: USD)

Average RSV-related treatment cost per patient by wGA age

We further examined the average RSV-related treatment costs per patient, categorised by the gestational age (wGA) of the infants during the one-year follow-up period following their initial RSV infection, as detailed in Fig. 2.

Our findings indicated significant cost variations among the different prematurity groups. Notably, the unhealthy extreme prematurity group (wGA ≤ 27) incurred the highest average RSV-related treatment cost per patient of $28,714 (95% CI: $22,747-$34,681). This was followed by unhealthy preterm infants with unspecified wGA ($7,614, 95% CI: $4,541-$10,688) and with 28–31 wGA ($6,777, 95% CI: $5,129-$8,424). Among late preterm infants, there was no significant difference in RSV-related treatment costs between the unhealthy and healthy groups. This analysis shows that extreme prematurity is a predominant factor driving healthcare costs.

Trends of average RSV-related treatment cost per patient

We found a trend of increasing RSV-related treatment costs per patient according to the year of infection in Fig. 3. In the overall population, the average RSV-related treatment cost per patient was $818 (95% CI: $799–$923) in 2017, $1,288 (95% CI: $1,196–$1,381) in 2018, $1,409 (95% CI: $1,274–$1,545) in 2019, $1,908 (95% CI: $1,611–$2,204) in 2020, and $3,338 (95% CI: $889–$5,787) in 2021. The average RSV-related treatment costs in 2020 showed an increase compared to the pre-COVID period, but the difference was not significant, and the 95% CI was overlaid on that of 2019. The highest costs were observed in 2021, although the number of infants was low (n = 78), and the 95% CI was extensive.

In the unhealthy preterm infant group, the average RSV-related treatment cost per patient increased consistently until 2020, rising from $10,369 (95% CI: $7,281–$13,457) in 2019 to $15,375 (95% CI: $10,338–$20,411) in 2020. Healthy preterm infants showed a steady increase in costs by 2021, from $1,866 (95% CI: $1,499–$2,234) in 2019 to $19,253 (95% CI: $-14,189–$52,695) in 2021. Full-term infants had rising costs up to 2019, with $1,091 (95% CI: $989–$1,192), but showed no significant difference in 2020 at $1,096 (95% CI: $987–$1,204) (Supplementary Table 1).

Discussion

In summary, our study provides substantial evidence that the treatment burden for infants under one year with confirmed RSV infection presents nationwide representative data on healthcare resource utilisation and treatment costs associated with the first RSV infection. Here, we present the analysis results stratified by health and gestational conditions before and during the COVID-19 pandemic. Our findings revealed that RSV infection in early life imposes a significant epidemiologic and economic burden, with infants at greater risk–shorter wGA and poorer health condition- experiencing substantially higher healthcare resource usage and costs, consistent with previous studies. Additionally, our study found no significant difference in RSV-related costs between healthy preterm and term infants once they were hospitalised, and highlighted the shift in the RSV burden during the COVID-19 period.

Our dataset, which included the most recent patient data up to 2021, captured changes in RSV healthcare utilisation during the pandemic. Notably, while the number of RSV cases significantly decreased during the COVID-19 era, the cost per patient increased, although this increase was not statistically significant. This trend, which highlights the persistent economic impact of RSV even as infection rates have fallen, is particularly relevant in the current healthcare landscape. This highlights the need for continued vigilance and resource allocation to manage the ongoing public health challenges.

In our study, 76.3% of the infants with confirmed RSV infection required intensive care, including hospitalisation and more critical interventions such as ICU or mechanical MV. While several studies have explored the overall burden of RSV, few have specifically examined healthcare utilisation for RSV among infants less than one year old at the population level. Previous studies have consistently reported a high prevalence of RSV among hospitalised infants presenting with respiratory symptoms. For instance, a recent study highlighted that RSV led to higher hospitalisation rates than other respiratory infections such as COVID-19 and influenza, especially in infants under one year [27]. Our results align with the findings of a 2008 study in which 73% of infants were hospitalised [15]. However, there are several studies reported lower RSV hospitalisation rates. Although there are limitations in comparability, a longitudinal study tracking 188 preterm infants with 32 − 25 wGA noted a 20% hospitalisation rate for confirmed RSV cases [16] and a 25% hospitalisation rate for patients less than two years of age with a broader definition of RSV [28]. A study of infants under six months old during the first RSV season reported that preterm infants had higher ICU and MV use than term infants, demonstrating a similar trend toward increased utilisation among preterm infants. With a generous definition of RSV extending to bronchiolitis, a recent study on infants with RSV showed an overall hospitalisation rate of approximately 20% in infants and a 32% hospitalisation rate in unhealthy infants [16, 29]. Our observed hospitalisation rate was higher than that in studies involving older children or broader RSV definition. There are possible hypotheses to explain this gap. First reason could be the underdiagnosis of RSV. Misclassification and issues with RSV coding may contribute to an underestimated disease burden due to the underdiagnosis of RSV [17, 30]. Moreover, discrepancies in coding practices across different regions and countries may have affected the underdiagnosis of RSV [31]. The second reason could be the difference between the healthcare system setting and social context. Notably, OECD statistics reveal that Korea has a significantly higher utilisation of healthcare resources and hospital beds than the OECD average, which could influence the heightened hospitalisation rates we observed. Additionally, higher inpatient rates of preterm infants in Korea support the explanation of the high hospitalisation rate in our findings [32, 33]. Given these complexities, our study underscores the need for more focused research on confirmed RSV cases, mainly because RSV infection in clinical settings is often more severe and requires substantial healthcare resources. Our findings advocate for more precise diagnostic practices for accurate disease coding and reporting.

Our findings indicate that, compared with healthy preterm and full-term infants, lower gestational age is associated with higher hospitalisation rates, intensive use of healthcare resources, and increased healthcare costs due to RSV, consistent with previous studies [4, 13, 14, 29, 34,35,36]. We found that the average RSV-related treatment cost per patient with confirmed RSV infection in unhealthy preterm infants under one year was approximately ten-fold higher than that in full-term infants and six-fold higher than that in healthy preterm infants. In terms of wGA, the costs of unhealthy preterm infants with wGA ≤ 27 were 33 times higher than that of full-term infants. The higher resource uses in premature infants is likely due to their increased RSV burden, a leading cause of hospitalization [37, 38]. Although, palivizumab is currently reimbursed for preterm infants born at less than 32 wGA, or those with chronic lung disease or hemodynamically significant congenial heart disease, the current efficacy of palivizumab or adherence to the drug may not be sufficient to prevent RSV from causing severe health outcomes for these population and further research on this issue is needed. Additionally, these unhealthy preterm infants showed markedly higher ICU admission rates (eight-fold higher than those of full-term infants), and MV usage was 19 times higher than that of full-term infants, with associated costs reflecting their increased risk and subsequent care needs. These findings correspond with studies that reported higher use of ICU and care fatality rates in vulnerable infants [4, 39,40,41]. RSV has a severe impact on lower-income countries; however, the RSV burden on infants remains significant even in high-income countries with robust healthcare systems, such as the USA, Japan, and South Korea [42]. This situation is further exacerbated by an increase in preterm and underweight births in South Korea, from 6.0% to 5.2% in 2011 to 9.2% and 7.2% in 2021, respectively [43]. The global increase in preterm births and projected increase in post-pandemic infections underscore the importance of preventing RSV-vulnerable newborns. We also need to address the severity of RSV impact regardless of prematurity. We found that there was no significant difference in RSV-related costs between healthy preterm and term once they were hospitalised, ICU admitted, or MV treatment was needed. To reduce the RSV burden for healthy preterm of full-term in intensive care unit, our findings suggest that public health interventions are essential.

This study tracked the trend of average RSV-related treatment costs per patient from 2017 to 2021; the trend’s slope was steeper during the COVID-19 period. Despite an 81% reduction in the weekly positive rate of RSV infection in South Korea during the COVID-19 pandemic, the average price per patient has surged, suggesting an increased disease burden and a decrease in numbers. This trend mirrors the patterns observed for other viruses during the pandemic and may have been influenced by temporary national policy factors, highlighting the need for further analytical studies to elucidate these dynamics. Although this increase of disease burden was not statistically significant compared to the previous year, it occurred alongside a marked decrease in RSV cases between 2020 and 2021. This paradoxical situation—rising costs despite fewer cases—may reflect the broader impact of the pandemic on the healthcare system. Limited evidence is available for comparison; however, the trend of declining RSV case numbers aligns with findings from local epidemiological studies based on surveillance systems during the same period. Notably, in 2020, the COVID-19 pandemic significantly reduced RSV detection rate, suppressed seasonal respiratory viruses such as RSV, and shifted the typical start of the RSV season from October to December [18, 44, 45]. These changes are likely attributable to the extensive social distancing and quarantine measures implemented globally, contributing to the overall reduction in respiratory infections [19, 46]. A possible explanation for the increased burden of RSV is the heightened susceptibility to viruses due to the lack of prior exposure during the COVID-19 pandemic, as detected in previous study [45]. This incomplete immunity may lead to a more severe disease course. Another hypothesis is that the severity of RSV is exacerbated by the interaction between SARS-CoV-2 and RSV, as suggested by recent research [47]. However, our analysis period, capped at April 2021, limits the exploration of post-pandemic cost trends. Future research could extend these findings to post-pandemic data to better understand evolving healthcare costs.

The limitations of our study primarily originate from the inherent nature of retrospective analyses using claims databases, including the inability to pinpoint exact birth dates and approximate gestational weeks using ICD-10 codes, leading to unspecified preterm categorisation unable to accurately estimate outcomes for each preterm gestational age categories. Additionally, we were not able to collect the data on socioeconomic factors such as family economic status and breastfeeding, which may affect the severity of infection and affordability of treatment. Research has demonstrated that breastfeeding infants recover more quickly, require less oxygen therapy, and benefit from the antibodies in human milk [48, 49]. In defining our study population, unhealthy preterm infants were identified as recipients of palivizumab, aligning with the eligibility criteria and emphasising their vulnerability to RSV infection. This inclusion criterion allowed us to examine the effectiveness of RSV prevention strategies by covering a segment of the population that is often excluded from randomised clinical trials [50]. However, this remains a limitation of the fine-tuned definition of an infant’s unhealthy condition. Thus, further studies are needed to explore how socioeconomic and other factors may impact on the burden of RSV infection, using a database with detailed variables.

Conclusion

RSV infections impose a significant disease burden and associated economic burden, with marked disparities among infant health status subgroups and weeks of gestational age. As anticipated, our study found high ICU or MV utilisation among unhealthy infants, underscoring the importance of targeted care for these vulnerable children. However, RSV prevention policies should also recognise that healthy preterm or full-term infants who receive intensive care face a significant disease burden. Therefore, universal RSV prevention coverage of all infants, regardless health condition, should be considered.

Fig. 1
figure 1

The proportion of RSV-related healthcare resource utilisation per patient. Note: Healthcare resource utilisation (HRU) categories were defined using a hierarchical approach, where each category (outpatient < emergency room [ER] < inpatient < intensive care unit [ICU] < mechanical ventilation [MV]) was mutually exclusive. For instance, individuals who utilised MV in the ICU were classified solely under the MV category but not counted in ICU category. According to this approach, if a patient was hospitalized and utilized MV, this patient was categorized to MV use but not to inpatient. Patients who were hospitalised but not admitted to ICU or not utilized MV, these patients were categorized to inpatient

Fig. 2
figure 2

The average RSV-related treatment cost per patient by wGA age

Fig. 3
figure 3

The average RSV-related treatment cost per patient and 95% CI from 2017 to 2021

Data availability

The datasets analysed in this study are not publicly available due to access restrictions imposed by the Korea Health Insurance Review and Assessment Service (HIRA). Data access requires permission from HIRA, following a formal data request.

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Funding

This study was supported by a grant (21153MFDS601) from the Ministry of Food and Drug Safety in 2024.

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Authors

Contributions

HJH and DR contributed equally to the conceptualisation, methodology, investigation, analysis, interpretation, visualisation, validation, original draft writing, and reviewing and editing. JYK contributed to the investigation, methodology, and manuscript writing. SJ contributed to project administration, data curation, methodology, and analysis. HSS contributed to the conceptualisation, funding acquisition, investigation, validation, draft writing, reviewing, and editing.

Corresponding author

Correspondence to Hae Sun Suh.

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Ethical approval and consent to participate

This study was conducted per the Declaration of Helsinki. The study protocol was reviewed and approved for a waiver of informed consent by the Institutional Review Board of Kyung Hee University (KHSIRB-22-529, 7 November 2022) due to using a retrospective database, ensuring confidentiality through encrypted, de-identified data.

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Not applicable.

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Han, H.J., Ryu, D., Kim, J.Y. et al. Healthcare resource utilisation and costs in infants with confirmed respiratory syncytial virus infections: a national population cohort study. BMC Infect Dis 24, 1152 (2024). https://doi.org/10.1186/s12879-024-09971-0

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