Trends and estimated costs of hospitalizations potentially associated with respiratory syncytial virus among children in Brazil, 2014-2025

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ABSTRACT Background: Respiratory syncytial virus, a major cause of respiratory infections and hospitalizations in young children, especially bronchiolitis, is an important burden to the health system in Brazil. This study evaluated the trends, seasonality, and economic impact of hospitalizations associated with respiratory syncytial virus in Brazilian children. Methods: This study analyzed hospitalizations for acute bronchitis and bronchiolitis (International Code of Diseases-10 J20-J21) in Brazilian children <5 years of age from January 2014 and March 2025 using data from the Brazil’s Unified Health System. Annual trends were assessed with linear regression, while time series decomposition evaluated seasonality. Direct medical costs were adjusted for inflation and converted to international dollars (Int$). Pearson’s correlation coefficient was employed to analyze associations between length of stay and hospitalization cost. Results: A total of 727,808 hospitalizations were recorded, with 86.8% occurring in children under 5 years old. Hospitalizations increased by 307.8%, with marked declines in 2020 during the coronavirus disease-2019 pandemic and consistent seasonal peaks between March-June. Direct medical costs totaled Int$ 166.8 million, with 55.5% of expenditures after 2020. The mean cost per hospitalization increased by Int$ 21.48 between 2014-2024 (Int$ 118.16-139.64). Length of stay correlated moderately with cost (r = 0.55), particularly strongly in southeastern and southern Brazil. Conclusions: Our findings revealed distinct seasonal and regional patterns in hospitalizations and a post-pandemic increase in costs. The association between prolonged hospitalization and higher expenditures underscores the need for targeted, region-specific preventive strategies and timely clinical interventions, to reduce the growing economic burden on the system.

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