P110: Real-World Healthcare Resource Utilization by Older Adults with RSV: A Retrospective Claims Analysis
Poster Presenter
Jenna Wildeman
PharmD Candidate
University of Washington United States
Objectives
The objective of this study is to characterize RSV-related healthcare resource utilization and costs for adults aged =60 years, using a retrospective claims analysis, and assess the impact of comorbid conditions on healthcare costs for inpatient, outpatient, and physician visits.
Method
Claims data from a regional health plan in New York state was analyzed. Adults aged =60 years diagnosed with RSV between July 1, 2022, and December 31, 2023, were included. Costs for prescription drugs, inpatient, outpatient, and physician visits were assessed six months before and after diagnosis.
Results
The analysis included 960 members aged =60 years diagnosed with RSV. After RSV diagnosis, healthcare utilization rose, with outpatient days increasing by 1.05 days and physician visits by 2.17 days, highlighting a substantial increase in RSV-related healthcare needs.
The average RSV-related cost per member was $4,215, totaling $4,046,534. Total cost increased by 34.9% ($4,896) in the 6 months post-diagnosis, with medical claims rising by 49.1% ($5,257) and prescription claims decreasing by 10.9% (-$361).
The most common comorbidities were cardiovascular (56.5%), pulmonary (48.9%), neurologic (31.8%), metabolic (31.0%), and immunocompromised (23.0%). Hepatic conditions had the highest RSV-related costs at $19,779 per member, followed by hematologic $8,005, renal $7,296, cardiopulmonary $7,284, neurologic $6,886, immunocompromised $6,685, pulmonary $6,462, cardiovascular $5,776, metabolic $5,686, and obesity $4,985. Inpatient costs account for the majority of incurred medical claims.
As the number of comorbidities increased, so did the average costs, rising from $530 with no comorbidities to $7,760 with five or more.
Conclusion
RSV diagnoses imposes a significant impact on healthcare costs, with an average expense of $4,215 per
member and a total expenditure exceeding $4 million for the studied cohort. After an RSV diagnosis, there is
a notable 34.9% increase in total costs per member, primarily driven by a 49.1% rise in medical claims. This
highlights a substantial escalation in healthcare needs and expenses following RSV.
Despite a 10.9% decrease in prescription claims, the overall cost impact is dominated by the increase in
inpatient medical claims. This indicates that the inpatient medical care associated with RSV is considerably
more expensive than outpatient care.
RSV diagnoses are often linked to various comorbidities, including cardiovascular, pulmonary, neurologic,
metabolic, and immunocompromised conditions. Among these, hepatic conditions incur the highest costs at
$19,779 per member, while obesity results in the lowest costs at $4,985. This suggests that focusing
vaccination efforts on individuals with high-risk and costly comorbidities could be particularly beneficial.
The cost of RSV increases with the number of comorbidities, which helps underscore the significant financial
burden RSV imposes in older adults, especially in those with multiple comorbidities. These findings align with updated CDC guidance recommending RSV vaccination for individuals 75 years and older and higher risk individuals 60-74 years with certain underlying conditions.
Optimizing vaccination strategies through member and healthcare provider education could mitigate the high costs associated with RSV and help prevent hospitalizations. Tailoring interventions to manage RSV in high-risk populations, specifically older adults with multiple comorbidities, can lower costs and enhance patient outcomes.
