Table4_Impact of RSV test positivity, patient characteristics, and treatment characteristics on the cost of hospitalization for acute bronchiolitis in a French university medical center (2010–2015).docx

BackgroundIn young children, respiratory syncytial virus (RSV)-related bronchiolitis is typically more severe than other respiratory tract infections, with a greater need for oxygen therapy and respiratory support. Few studies have compared the cost of hospitalization with regard to virological status. The objective of this study was to compare the costs of hospitalization for RSV-positive vs. RSV-negative bronchiolitis in a French university medical center between 2010 and 2015.
MethodsThe cost models were compared using conventional goodness-of-fit criteria. Covariates included the characteristics of the patients, pre-existing respiratory and non-respiratory comorbidities, superinfections, medical care provided, and the length of stay.
ResultsRSV was detected in 679 (58.3%) of the 1,164 hospital stays by children under 2 years with virological data. Oxygen therapy and respiratory support were twice as frequent for the RSV-positive cases. The median hospitalization cost was estimated at €3,248.4 (interquartile range: €2,572.1). The cost distribution was positively skewed with a variation coefficient (CV = standard deviation/mean) greater than one (mean = €4,212.9, standard deviation = €5,047, CV = 1.2). In univariate analyses, there was no significant cost difference between the RSV-positive and RSV-negative cases. In the best multivariate model, the significant positive effect of RSV positivity on cost waned after the introduction of medical care variables and the length of stay. The results were sensitive to the specification of the model.
ConclusionsIt was impossible to firmly conclude that hospitalization costs were higher for the RSV-positive cases.

背景：对于幼儿而言，呼吸道合胞病毒（respiratory syncytial virus, RSV）相关细支气管炎的严重程度通常高于其他呼吸道感染，患儿对氧疗与呼吸支持的需求更高。目前鲜有研究针对病毒学状态对比相关住院费用差异。本研究旨在对比2010至2015年间，法国某大学医疗中心内，RSV阳性与RSV阴性细支气管炎患儿的住院费用。
方法：本研究采用常规拟合优度准则对费用模型进行对比分析。协变量涵盖患者特征、既往呼吸与非呼吸共病、重叠感染、所提供的医疗服务以及住院时长。
结果：在1164例拥有病毒学数据的2岁以下儿童住院病例中，679例（58.3%）检测出RSV阳性。RSV阳性患儿接受氧疗与呼吸支持的频率是阴性组的两倍。中位住院费用估算为3248.4欧元（四分位间距：2572.1欧元）。费用分布呈正偏态，变异系数（CV=标准差/均值）大于1（均值=4212.9欧元，标准差=5047欧元，CV=1.2）。单因素分析显示，RSV阳性与阴性组间住院费用无显著差异。在最优多因素模型中，纳入医疗服务变量与住院时长后，RSV阳性对住院费用的显著正向影响有所减弱。研究结果对模型的设定方式具有敏感性。
结论：无法确凿判定RSV阳性患儿的住院费用更高。