Quality of life burden on United States infants and caregivers due to lower respiratory tract infection and adjusting for selective testing: Pilot prospective observational study

Dhwani Hariharan; V S Senthil Kumar; Elizabeth L Glaser; William H Crown; Zachary A Wolf; Kimberley A Fisher; Charles T Wood; William F Malcolm; Christopher B Nelson; Donald S Shepard

doi:10.1002/hsr2.1338

Quality of life burden on United States infants and caregivers due to lower respiratory tract infection and adjusting for selective testing: Pilot prospective observational study

Health Sci Rep. 2023 Jun 16;6(6):e1338. doi: 10.1002/hsr2.1338. eCollection 2023 Jun.

Affiliations

¹ Heller School for Social Policy and Management Brandeis University Waltham Massachusetts USA.
² Clinetic Durham North Carolina USA.
³ Duke University School of Medicine Duke University Durham North Carolina USA.
⁴ Medical Evidence Generation Sanofi Swiftwater Pennsylvania USA.

Abstract

Background and aims: Policymakers need data about the burden of respiratory syncytial virus (RSV) lower respiratory tract infections (LRTI) among infants. This study estimates quality of life (QoL) for otherwise healthy term US infants with RSV-LRTI and their caregivers, previously limited to premature and hospitalized infants, and corrects for selective testing.

Methods: The study enrolled infants <1 year with a clinically diagnosed LRTI encounter between January and May 2021. Using an established 0-100 scale, the 36 infants' and caregivers' QoL at enrollment and quality-adjusted life year losses per 1000 LRTI episodes (quality-adjusted life years [QALYs]/1000) were validated and analyzed. Regression analyses examined predictors of RSV-testing and RSV-positivity, creating modeled positives.

Results: Mean QoL at enrollment in outpatient (n = 11) LRTI-tested infants (66.4) was lower than that in not-tested LRTI infants (79.6, p = 0.096). For outpatient LRTI infants (n = 23), median QALYs/1000 losses were 9.8 and 0.25 for their caregivers. RSV-positive outpatient LRTI infants (n = 6) had significantly milder QALYs/1000 losses (7.0) than other LRTI-tested infants (n = 5)(21.8, p = 0.030). Visits earlier in the year were more likely to be RSV-positive than later visits (p = 0.023). Modeled RSV-positivity (51.9%) was lower than the observed rate (55.0%). Infants' and caregivers' QALYs/1000 loss were positively correlated (rho = 0.34, p = 0.046), indicating that infants perceived as sicker imposed greater burdens on caregivers.

Conclusions: The overall median QALYs/1000 losses for LRTI (9.0) and RSV-LRTI (5.6) in US infants are substantial, with additional losses for their caregivers (0.25 and 0.20, respectively). These losses extend equally to outpatient episodes. This study is the first reporting QALY losses for infants with LRTI born at term or presenting in nonhospitalized settings, and their caregivers.

Keywords: RSV; caregiver; lower respiratory tract infection; quality of life; quality‐adjusted life year (QALY); respiratory syncytial virus.