Background The implementation of the approved respiratory syncytial virus (RSV) preventive interventions in immunisation programmes is advancing rapidly. Insight into healthcare costs of RSV-related paediatric intensive care unit (PICU) admissions is lacking, but of great importance to evaluate the impact of implementation. Therefore, this study aimed to determine the total annual RSV-related paediatric intensive care healthcare costs in the Netherlands. Methods A nationwide prospective, observational, multicenter study was performed from September 2021 until June 2023. The total annual RSV-related healthcare costs on PICUs in the Netherlands were calculated using RSV-related costs (subgroup I) and consequential costs (subgroup II and III). Subgroup I comprised all PICU admitted infants <= 12 months of age with laboratory-con fi rmed RSV infection. Subgroup II and III consisted of postponed elective PICU admissions and refused acute PICU admissions due to RSV-related lack of PICU capacity. Findings A total of 424 infants with RSV-related PICU admission were included. Median age at PICU admission was 46 days (IQR 25 - 89). The median length of PICU admission was 5 days (IQR 3 - 8). The total RSV-related PICU costs are <euro> 3,826,386 in 2021 - 2022, and <euro> 3,183,888 in 2022 - 2023. Potential costs averted by RSV preventive interventions is <euro> 1.9 to <euro> 2.6 million depending on season, and the duration of protection. Interpretation RSV-related PICU admissions cost <euro> 3.1 to <euro> 3.8 million in the Netherlands during one season. The introduction of new RSV preventive interventions into the Dutch immunisation programme will generate signi fi cant cost-savings on PICUs and decreases the admission burden of PICUs.