{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:10:43Z","timestamp":1768569043973,"version":"3.49.0"},"posted":{"date-parts":[[2024,7,17]]},"group-title":"Health Economics","reference-count":16,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,7,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Non-disease-specific WHO-CHOICE unit costs are often used in cost and cost-effectiveness studies in the absence of country-specific data. This study aims to compare reported country-specific disease costs and the corresponding WHO-CHOICE estimates. We use generically defined \u201cdiarrhea\u201d (including rotavirus diarrhea) and pathogen-specific \u201crespiratory syncytial virus (RSV)\u201d disease as examples.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We updated systematic reviews for both diseases in low-income (LICs), lower-middle-income (LMICs) and upper-middle-income (UMICs) countries. Diarrheal (including a sub-analysis of rotavirus-specific) and RSV-specific outpatient and inpatient costs per episode were extracted and compared with WHO-CHOICE estimates in the same countries. If a consistent pattern of under- or over-estimation was identified, we quantified the magnitude of the discrepancy. All costs were updated to 2022 international dollar values.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Out of 1975 new records identified, 23 new cost studies were included. Including previous reviews, we retained 31 diarrhea and 16 RSV studies for comparison. WHO-CHOICE based direct medical costs were similar for diarrheal disease including rotavirus diarrhea, but lower for RSV-related disease. We estimated the cost per episode of diarrhea and RSV in 128 countries. RSV outpatient cost were adjusted by multiplying WHO-CHOICE costs by 6.89 (95% uncertainty interval: 5.58-8.58) in LICs and LMICs and 5.87 (4.95-6.96) in UMICs; RSV inpatient costs were multiplied by 1.43 (1.01-2.01) and 1.36 (0.82-2.27), respectively.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>WHO-CHOICE based costs should be used cautiously. They aligned well with studies for diarrheal disease, but underestimate costs of RSV-related disease. More country- and disease-specific cost data are needed, especially for RSV in LICs.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2024.07.17.24310217","type":"posted-content","created":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T20:20:19Z","timestamp":1721247619000},"source":"Crossref","is-referenced-by-count":1,"title":["Cost per episode of diarrhea and respiratory syncytial virus (RSV) in 128 low- and middle-income countries: how well do disease-specific and WHO-CHOICE estimates align?"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1918-1791","authenticated-orcid":false,"given":"Xiao","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5720-5291","authenticated-orcid":false,"given":"Joke","family":"Bilcke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4078-8755","authenticated-orcid":false,"given":"Ernest O.","family":"Asare","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5564-0630","authenticated-orcid":false,"given":"Catherine","family":"Wenger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2707-3547","authenticated-orcid":false,"given":"Jiye","family":"Kwon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3099-4475","authenticated-orcid":false,"given":"Louis","family":"Bont","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5034-3595","authenticated-orcid":false,"given":"Philippe","family":"Beutels","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1015-2289","authenticated-orcid":false,"given":"Virginia E.","family":"Pitzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2024071903450914000_2024.07.17.24310217v1.1","unstructured":"Unicef. Under-five mortality 2023 [updated 01\/2023. Available from: https:\/\/data.unicef.org\/topic\/child-survival\/under-five-mortality\/#:~:text=Globally%2C%20infectious%20diseases%2C%20including%20pneumonia,birth%20and%20intrapartum%2Drelated%20complications. accessed 12\/02 2024."},{"key":"2024071903450914000_2024.07.17.24310217v1.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-062360"},{"key":"2024071903450914000_2024.07.17.24310217v1.3","unstructured":"PATH. RSV Vaccine and mAB Snapshot 2024 [updated 01\/2024. Available from: https:\/\/www.path.org\/our-impact\/resources\/rsv-vaccine-and-mab-snapshot\/ accessed 13\/02 2024."},{"key":"2024071903450914000_2024.07.17.24310217v1.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2009.06.035"},{"key":"2024071903450914000_2024.07.17.24310217v1.5","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piaa157"},{"key":"2024071903450914000_2024.07.17.24310217v1.6","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2019.1671134"},{"key":"2024071903450914000_2024.07.17.24310217v1.7","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-023-02792-z"},{"key":"2024071903450914000_2024.07.17.24310217v1.8","doi-asserted-by":"publisher","DOI":"10.1186\/s12962-018-0095-x"},{"key":"2024071903450914000_2024.07.17.24310217v1.9","unstructured":"World Health Organization. WHO guide for standardization of economic evaluations of immunization programmes. In: Immunization VaB , ed. 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