An overview of the latest Saudi evidence presented at ESPID 2026.
INTRODUCTION
- RSV is a leading cause of LRTIs in Saudi Arabia and globally, accounting for 15%-50% of LRTI cases in infants.1
- RSV presents a substantial clinical and economic burden in Saudi Arabia, with pediatric primary care admission rates of 60.6% and estimated costs of SAR 280-340 million. 2
- While international cost estimates are readily available, data from the Gulf region remains limited.
- This underscores the urgent need to understand the healthcare resource utilization and direct medical costs of RSV in pediatric population for effective prevention and management strategies in Saudi Arabia.
OBJECTIVE
This study aims to assess healthcare resource utilization and direct medical costs associated with laboratory-confirmed RSV among children <5 years in Saudi Arabia and contextualized findings within global cost evidence.
METHODS
Study Design And Setting
This retrospective cost analysis was 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
| Variables | < 1 month (n=373) |
1-2 months (n=1226) |
3-5 months (n=1100) |
6-11 months (n=1355) |
12-17 months (n=960) |
18-23 months (n=547) |
|---|---|---|---|---|---|---|
| ICU admission cost | 514,800 | 1,105,650 | 234,000 | 409,617 | 587,087 | 117,000 |
| Ward admission cost | 787,050 | 2,280,163 | 1,637,700 | 1,932,000 | 1,494,588 | 720,300 |
| Emergency Department/Outpatient visit cost | 149,200 | 490,400 | 440,000 | 542,000 | 384,000 | 218,800 |
| Diagnostic and Treatment cost | 225,150 | 732,450 | 618,450 | 781,850 | 575,700 | 329,650 |
| Overall direct medical cost | 1,676,200 | 4,608,663 | 2,930,130 | 3,665,467 | 3,041,375 | 1,385,750 |
| Average direct medical cost per case | 4493.83 | 3759.11 | 2663.77 | 2705.14 | 3168.10 | 2533.36 |
| Variables | Y2018 (n=1037) |
Y2019 (n=1248) |
Y2020 (n=699) |
Y2021 (n=794) |
Y2022 (n=2590) |
Y2023 (n=1003) |
|---|---|---|---|---|---|---|
| ICU admission cost | 171,405 | 122,850 | 115,128 | 957,528 | 1,507,838 | 565,208 |
| Ward admission cost | 357,675 | 502,775 | 186,250 | 2,730,163 | 8,309,600 | 1,924,950 |
| Emergency Department/Outpatient visit cost | 414,800 | 499,200 | 279,600 | 317,600 | 1,036,000 | 401,200 |
| Diagnostic and Treatment cost | 241,300 | 330,600 | 149,150 | 684,000 | 2,393,050 | 624,150 |
| Overall direct medical cost | 1,185,180 | 1,455,425 | 730,128 | 4,689,291 | 13,246,488 | 3,515,508 |
| Average direct medical cost per case | 1142.89 | 1166.21 | 1044.53 | 5905.91 | 5114.47 | 3504.99 |
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.
-
Du Y, et al. Int J Infect Dis. 2023;135:70-76.
-
Alharbi A, et al. Adv Ther. 2024;41(4):1419-1435.
-
Bechini A, et al. Public Health. 2024;227:103-111.
-
Demont C, et al. BMC Infect Dis. 2021;21(1):730.
-
Tan CJ, et al. Pediatr Infect Dis J. 2023;42(10):883-887.
-
Dvorkin J, et al. BMC Public Health. 2024;24(1):427.
-
Martinón-Torres F, et al. BMC Infect Dis. 2023;23(1):385.
-
Ignatyeva VI, et al. Farmakoekonomika Mod Pharmacoecon Pharmacoepidemiol. 2023;16(4):517-525.
-
Khaing W, et al. Influenza Other Respir Viruses. 2024;18(11):e70039.
-
Moyes J, et al. 2025;
-
Do LAH, et al. BMC Infect Dis. 2023;23(1):73.
-
Ren L, et al. Influenza Other Respir Viruses. 2023;17(8):e13180.
-
von Linstow ML, et al. BMC Infect Dis. 2024;24(1):1098.
-
Dovizio M, et al. Ital J Pediatr. 2024;50(1):57.
-
Tilmanne A, et al. Vaccine. 2025;55:127065.
ARI, Acute Respiratory Infection; ARS, Argentine Peso; BESTCare, Best Electronic System for Total Care; CNY, Chinese Yuan; EUR, Euro; ESPID, European Society for Pediatric Infectious Diseases; ICU, Intensive Care Unit; IQR, Interquartile Range; LRTI, Lower Respiratory Tract Infection; MNGHA, Ministry of National Guard Health Affairs; n, Number; QR, Quick Response; RUB, Russian Ruble; RSV, Respiratory Syncytial Virus; SAR, Saudi Arabian Riyal; THB, Thai Baht; VND, Vietnamese Dong; ZAR, South African Rand
DISCLOSURES
Conflict of Interest: MALS, FF, MALZ, KALS, AALS, MALA, WA, SN, AE, AELS, AAS declare no conflict of interest. LB, GW, AA, and BD are employees of Sanofi and may hold stocks/shares in the company
ACKNOWLEDGEMENTS
Medical writing and editing support was provided by Khushboo Lakhani, Scientific Writer, Sanofi
FUNDING
This study was funded by Sanofi and AstraZeneca.
Healthcare Resource Utilization and Direct Medical Costs of RSV Infection in Children Under Five Years in Saudi Arabia
- Annual direct medical costs associated with RSV reached SAR 13.2 million during the 2022 season.
- Infants aged 1–2 months accounted for the highest overall direct medical costs (SAR 4.6 million).
- The highest average cost per case was observed in infants <1 month (SAR 4,493.83 per case).
- Inpatient ward admissions constituted the main cost component, while healthy infants <1 year represented the largest group requiring RSV-associated hospitalization.
