Low Levels of RSV Testing Among Adults Hospitalized for Lower Respiratory Tract Infection in the United States

Mark H Rozenbaum; Jen Judy; Diana Tran; Kari Yacisin; Samantha K Kurosky; Elizabeth Begier

doi:10.1007/s40121-023-00758-5

Low Levels of RSV Testing Among Adults Hospitalized for Lower Respiratory Tract Infection in the United States

Infect Dis Ther. 2023 Feb;12(2):677-685. doi: 10.1007/s40121-023-00758-5. Epub 2023 Jan 27.

Authors

Mark H Rozenbaum¹, Jen Judy², Diana Tran³, Kari Yacisin⁴, Samantha K Kurosky⁵, Elizabeth Begier⁶

Affiliations

¹ Pfizer bv, Capelle aan den IJssel, The Netherlands.
² Pfizer Inc, New York, NY, USA. Jennifer.Judy@pfizer.com.
³ EVERSANA, Burlington, ON, Canada.
⁴ Pfizer Vaccines, Collegeville, PA, USA.
⁵ Pfizer Inc, New York, NY, USA.
⁶ Pfizer Vaccines, Dublin, Ireland.

Abstract

Introduction: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI)-related hospitalizations in older adults. Without RSV-specific treatment for adults, testing is uncommon, leading to potential underestimation of RSV incidence in real-world data studies. This study aimed to quantify the frequency of RSV testing during LRTI-related hospitalizations of older adults to inform interpretation of incidence estimates.

Methods: Administrative and billing data for hospitalizations of adults aged ≥ 65 years with a primary or secondary diagnosis of LRTI during the 2016-2019 RSV seasons (October-April) were extracted from the US all-payer Premier Healthcare Database (PHD). Billing codes identified RSV tests administered during eligible hospitalizations. The proportion of LRTI-related hospitalizations with a billed RSV test was calculated for each hospital in PHD, and summarized descriptively by hospital bed size, teaching status, and population served.

Results: Most of the 937 study hospitals performed RSV testing infrequently during LRTI hospitalization; median percentage of LRTI hospitalizations with RSV testing was 4.3%, and 78.4% of hospitals performed RSV testing in less than 25% of LRTI-related hospitalizations. RSV testing varied extensively by hospital type. Median percentage tested was significantly higher for hospitals with ≥ 200 beds (9.1%) versus < 200 beds (1.6%), for teaching (11.0%) versus non-teaching (2.5%) hospitals, and in urban (7.4%) versus rural (0.7%) settings. The median percentage of RSV testing increased over time, from 0.8% to 6.3% between the 2016/17 and 2018/19 seasons.

Conclusion: A small proportion of older adults hospitalized with LRTI are tested for RSV in US hospitals. Large variability occurs across hospital types. Consequently, retrospective database analyses likely result in a substantial underestimation of the true RSV-related hospitalization incidence. RSV incidence studies using real-world data need to assess for RSV testing frequency and adjust their results for under ascertainment associated with limited testing.

Keywords: Lower respiratory tract infection (LRTI); RSV testing; Respiratory syncytial virus (RSV).