RSV-related hospital admissions in a subset of hospitals in England and Scotland: A real-world study (2018–2023)

Respiratory syncytial virus (RSV) is a major cause of acute respiratory infection (ARI), though its healthcare burden and costs are insufficiently described among adults in the United Kingdom. With the recent availability of vaccines, understanding RSV-related secondary care burden is essential. Routinely collected adult ARI hospitalization data between 2018 and 2023 from four English National Health Service (NHS) trusts and a Scottish Health Board were linked to RSV, influenza, and coronavirus disease 2019 (COVID-19) microbiology tests and results. ARI incidence risk and ARI-related hospitalizations overall and per pathogen were described (including mortality, hospitalization length of stay [LoS], intensive care unit [ICU] admissions/LoS, and costs). RSV-positive microbiology tests and International Classification of Diseases (ICD)-10 RSV diagnoses were compared. In both settings, incidence risk of first ARI hospitalizations increased from 2018/19 to 2022/23. Of RSV-tested hospitalizations, 7.0% (England) and 4.1% (Scotland) had an RSV-positive test. Of these, 7.4% and 8.0% died in hospital, respectively; similar proportions were observed for influenza (5.5% and 5.0%). In England and Scotland, RSV-positive hospitalization LoS was 5 and 6 d, comparable to COVID-19 (8 and 10) and influenza (4 and 3). ICU admittance and direct costs per hospitalization were generally comparable across pathogens. In England and Scotland, 63.5% and 33.7% of RSV-positive hospitalizations had an RSV ICD-10 code, respectively. Among English and Scottish adults, RSV-positive hospitalizations had substantial healthcare resource utilization, comparable to COVID-19- and influenza-positive hospitalizations. ICD-10 codes are limited proxies for identifying RSV hospitalizations. Broadening RSV adult vaccination recommendations may reduce the RSV secondary care burden.