Clinical characteristics, health care resource utilization and direct medical costs of Rotavirus hospitalizations in Spain (2013–2018)

Figures & data

Table 1. Epidemiological characteristics of RVGE episodes hospitalized in children <5 years of age

Epidemiological Characteristics	N subjects/ Total sample	Percentage
Previous conditions
Prematurity	131/981	13.4%
≤32 weeks	46/130	35.4%
≤37 weeks	84/130	64.6%
Low birth weight	98/970	10.1%
≤2,500 g	66/97	68.0%
≤1,500 g	31/97	32.0%
Malabsorption syndrome	12/994	1.2%
Gastroesophageal Reflux Disease	18/992	1.8%
Chronic disease	193/1.001	19.3%
Pneumopathy	41/193	21.2%
Gastrointestinal disorders	36/193	18.7%
Cardiopathy	32/193	16.6%
Encephalopathy	28/193	14.5%
Nephropathy	25/193	13.0%
Failure to thrive	16/193	8.3%
Endocrine/Metabolic disorders	16/193	8.3%
Chromosome disorders	13/193	6.7%
Others	48/193	24.9%
Type of feeding at hospital admission time
Nursing children	456/750	60.8%
Breastfeeding	119/456	26.1%
Formula	253/456	55.5%
Mixed	84/456	18.4%
Day care or school attendance	147/544	27.0%
Household contacts with similar symptoms	153/719	21.3%

N subjects: number of subjects presenting the condition or characteristic; Total sample: number of subjects for which the information was available.

Figure 1. Frequency of complications reported in RVGE hospitalization episodes in children <5 years of age.

Table 2. Pharmacological and therapeutic interventions for the RVGE episodes before and during hospitalization

	N subjects/ Total sample	Percentage	Mean Duration (SD)
Pharmacological treatments
Prior to hospitalization	150/973	15.4%
Analgesics	3/150	2.0%	2.00 (1.00) d
Antipyretics	49/150	32.7%	2.44 (1.54) d
Antidiarrheal/antisecretory agents	2/150	1.3%	——
Antiemetics	24/150	16.0%	1.68 (.75) d
Antibiotics	23/150	15.3%	2.87 (2.03) d
Oral rehydration solutions	71/150	47.3%	2.42 (1.19) d
Probiotics	6/150	4.0%	4.60 (5.86) d
Other	27/150	18.0%	46.13 (103.10) d
During hospitalization	306*/991	30.9%
Antibiotics	133/306	43.5%	5.31 (3.29) d
Antipyretics	117/306	38.2%	1.90 (1.28) d
Oral rehydration solutions	89/306	29.1%	1.98 (1.34) d
Antiemetics	46/306	15.0%	3.03 (7.55) d
Analgesics	27/306	8.8%	2.44 (1.46) d
Gastric protectors	18/306	5.9%	9.91 (12.53) d
Vitamins and iron supplements	18/306	5.9%	16.78 (15.78) d
Respiratory drugs	16/306	5.2%	5.42 (3.70) d
Corticosteroids	14/306	4.6%	6.89 (3.76) d
Anticonvulsants	7/306	2.3%	2.00 (1.73) d
Benzodiazepines	6/306	2.0%	1.00 (.00) d
Probiotics	5/306	1.6%	4.67 (3.06) d
Diuretics	4/306	1.3%	20.00 (.) d
ACE inhibitors	4/306	1.3%	——–
Antihypertensive agents	3/306	1.0%	——–
Amino acids and derivatives	3/306	1.0%	19.00 (.) d
Antidiarrheal/antisecretory agents	2/306	0.7%	10.00(.) d
Other	22/306	7.2%	8.42 (9.45) d
Dietary and hygiene measures during hospitalization
IV fluid replacement	785/988	79.5%	33.31 (34.67) h
IV bicarbonate	40/997	4.0%	0.59 (7.02) h
Special diets	56/996	5.6%
Lactose-free milk	25/56	44.6%	0.03 (.42) d
Casein hydrolysate	16/56	28.6%	0.06 (.61) d
Whey protein hydrolysate	4/56	7.1%	0.01 (.11) d
Hydrolyzed other	4/56	7.1%	0.00 (.10) d
Parenteral nutrition	9/56	16.1%	0.03 (.39) d
Nasogastric tube feeding (N = 994)	22/994	2.2%	0.06 (.98) d

N subjects: number of subjects with a treatment; Total sample: number of subjects for which the information was available; **306 RVGE episodes with a total of 534 pharmacologic treatments.

SD = Standard deviation; ACE inhibitors = angiotensin-converting enzyme inhibitors; IV = intravenous; h = hours; d = days.

Table 3. Diagnostic test performed for RVGE confirmation at admission and other tests during hospitalization

Diagnostic tests	N subjects/ Total sample	Percentage	N of tests Mean (SD)
Test performed for microbiological diagnosis of RVGE	1.002/1.002	100%
Immunochromatography	930/1.002	92.8%	0.95 (.45)
ELISA	1/1.002	0.1%	0.00 (.03)
Stool culture	284/1.002	28.3%	0.30 (.52)
PCR	82/1.002	8.2%	0.09 (.31)
Other	8/1.002	0.8%	0.01 (.0)
Tests for detection of coinfection with other pathogens	935/995	94.0%
Adenovirus	858/935	91.8%	——–
Positive	28/858	3.3%	——–
Norovirus	131/935	14.0%	——–
Positive	2/131	1.5%	——–
Sapovirus	54/935	5.8%	——–
Positive	2/54	3.7%	——–
Coronavirus	2/935	2%	——–
Positive	0/2	0.0%	——–
Bocavirus	3/935	3%	——–
Positive	0/3	0.0%	——–
Bacteriae (stool culture)	670/935	71.7%	——–
Positive	20/670	3.0%	——–
Others	332/935	35.5%	——–
Positive	14/332	4.2%	——–
Other diagnostic tests	901*/999	90.2%
Blood tests	844/901	93.7%
Complete blood count	752/844	89.1%	1.22 (1.43)
Biochemistry	790/844	93.6%	1.61 (2.33)
Coagulation	47/884	5.6%	0.08 (.52)
Other	99/884	11.2%	0.25 (.64
Blood gases	673/901	74.7%	1.31 (1.78)
Abdominal ultrasound scan	41/901	4.6%	0.05 (.24)
Abdominal/plain X-rays	49/901	5.4%	0.09 (.73)
Ultrasound	26/901	2.9%	0.03 (.23)
CT scan	8/901	9%	0.01 (.09)
MRI	2/901	2%	0.00 (.04)
Urinalysis	99/901	11.0%	0.12 (.39)
Culture	344/901	38.2%	0.38 (.84)
ECG and EEG	28/901	3.1%	0.03 (.17)
ECG	10/28	35.7%
EEG	18/28	64.3%
Other tests	24/901	2.7%	0.02 (.19)

Notes: N subjects: number of subjects with a diagnostic test; Total sample: number of subjects for which the information was available.; *901 RVGE episodes with a total of 2,138 diagnostic tests performed.

ELISA = Enzyme-linked immunoassay; PCR = Polymerase Chain Reaction; CT scan = Computerized tomography scan; MIR = Magnetic Resonance Imaging; ECG = Electrocardiogram; EEG = Electroencephalogram.

Table 4. Direct Medical Costs (€) related to the RVGE episodes

Direct Medical Costs (€)	Global	2013-2014 (N=199)	2014-2015 (N=226)	2015-2016 (N=165)	2016-2017 (N=222)	2017-2018 (N=182)	p-value^1
During hospitalization
Hospital stay (Ward)	3,676.63	3,949.32	3,753.12	3,602.46	3,883.43	3098.48	0.7977
Mean (SD)	(5,013.00)	(5,920.96)	(5,341.70)	(5,365.19)	(5,036.95)	(2550.77)
Hospital stay (ICU)	62.11	27.27	126.08	41.12	73.34	26.09	0.4929
Mean (SD)	(498.74)	(271.36)	(793.99)	(315.16)	(527.09)	(250.77)
Microbiological diagnostic test Mean (SD)	26.01 (45.17)	24.81 (10.71)	30.78 (92.58)	23.68 (11.05)	24.82 (11.93)	24.99 (9.71)	0.6793
Other diagnostic tests	76.74	68.68	80.18	77.46	73.54	84.51	0.3027
Mean (SD)	(100.23)	(82.76)	(102.76)	(79.43)	(78.85)	(144.99)
Pharmacologic treatments	1.65	1.29	2.07	2.68	1.02	1.35	0.4272
Mean (SD)	(9.58)	(4.19)	(6.80)	(20.51)	(3.65)	(5.31)
Hygienic-dietary measures	97.24	36.69	153.64	121.99	112.04	52.93	0.6960
Mean (SD)	(645.81)	(238.63)	(827.24)	(965.49)	(586.08)	(316.76)
Total direct hospitalization	3,940.38	4,108.07	4,145.86	3,869.38	4,168.19	3,288.36	0.8794
Mean (SD)	(5,248.85)	(5,955.87)	(5,921.35)	(5,556.53)	(5,181.77)	(2,723.54)
Prior to hospitalization
ER visits	103.34	103.70	102.21	97.07	103.67	110.85	0.9114
Mean (SD)	(137.66)	(140.91)	(140.19)	(129.77)	(137.17)	(139.59)
Outpatient visits	25.98	25.53	27.99	18.23	21.95	35.90	0.0089
Mean (SD)	(58.93)	(60.29)	(64.31)	(47.15)	(55.39)	(63.18)
Prior pharmacologic treatments Mean (SD)	0.41 (1.64)	0.51 (1.85)	0.40 (1.57)	0.56 (1.92)	0.34 (1.60)	0.29 (1.20)	0.2794
After hospitalization
Rehospitalization length of stay	30.00	9.99	123.15	0.00	0.00	0.00
Mean (SD)	(727.54)	(140.92)	(1,518.95)	(.00)	(.00)	(.00)	0.1269
Total costs related with the RVGE episode Mean (SD)	4,100.11 (5,283.63)	4,247.80 (5,932.51)	4,399.61 (6,100.49)	3,985.23 (5,536.02)	4,293.15 (5,171.30)	3,435.39 (2,708.19)	8323

SD: Standard deviation; ER: Emergency room; Each season includes data from June of the previous year to May of the next. ¹Kruskal-Wallis t.