Efficacy of a Novel Palivizumab Prophylaxis Protocol for Respiratory Syncytial Virus Infection in Congenital Heart Disease: A Multicenter Study

Chiu, Shuenn–Nan; Wang, Jieh Neng; Fu, Yun Ching; Chung, Hung Tao; Chang, Ling-Yin; Wu, Mei; Yu, Hanjie; Lin, Ming Tai; Lu, Chun‐Wei; Wu, Jing Ming; Wang, Jou‐Kou

doi:10.1016/j.jpeds.2017.11.044

Cited by 10 publications

(12 citation statements)

References 24 publications

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“…Chiu et al from Taiwan reported the use of a novel palivizumab prophylaxis protocol, involving 6 monthly injections commencing right after diagnosis of HsCHD has been made, and concluded that to be effective in preventing RSVh. [16] However, the study was limited by its low baseline RSVh rate of 4.8% only from a historical cohort as compared with 11% of our cohort which is more in line with other published data. [6,12,26] Our 3-year study with a range RSV circulation activity provided a better estimation of the effectiveness of palivizumab prophylaxis in areas without a sharp RSV season.…”

Section: Discussionsupporting

confidence: 89%

“…Since there is no discrete RSV season locally, the calculation was made based on the rst dose of palivizumab being administered upon rst hospital discharge after which the diagnosis of HsCHD was made as advocated by the Taiwan group. [16] The RSVh identi ed in this cohort were deemed to be potentially preventable by palivizumab if it fell within the duration of prophylaxis course up to within 4 weeks after the last presumed dose of palivizumab; RSVh falling outside this period would be regarded as not preventable. The relative reduction of episodes of RSVh and days of RSVh by a Palivizumab program was presumed to be 0.45 and 0.56 respectively based on the study from Felts et al [12].…”

Section: Cost Analysis and Potential E Cacy Of Palivizumab Programmentioning

confidence: 99%

“…The cost for a standard 5 dose regimen and an alternative 6 dose regimen was calculated. [16] Due to the con icting evidence in the e cacy of palivizumab in cyanotic HsCHD, separate cost calculations were made to include only the heart failure and the PHT group. Since there were signi cant variations in the logistics of administration in different regional hospitals, the administrative cost was not included in the calculation.…”

Section: Cost Analysis and Potential E Cacy Of Palivizumab Programmentioning

confidence: 99%

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Population-based Respiratory Syncytial Virus Hospitalization Disease Burden and Cost Effectiveness of Palivizumab Prophylaxis in Infants with Hemodynamically Significant Congenital Heart Diseases

Chen

Chiu

Lee

et al. 2020

Preprint

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Abstract Background Infants with hemodynamically significant congenital heart disease (HsCHD) are at risk of respiratory syncytial virus hospitalization (RSVh) and Palivizumab has been shown to be effective in preventing RSVh in regions with a distinct RSV season. However, the incidence of RSVh in HsCHD patients and the cost-effectiveness of Palivizumab in regions with year-round RSV activity is largely unknown. Methods All HsCHD patients < 12 months of age referred to the only tertiary pediatric cardiology center in Hong Kong during 1 Jan 2014 to 31 Dec 2016 were included. RSVh rate, Palivizumab efficacy and cost-effectiveness were assessed using a 5 or 6 monthly dose regimen starting from first hospital discharge. Results Twenty-six RSVh (11%) were identified out of 236 HsCHD patients. 222 patients were included for further analysis of Palivizumab efficacy and cost-effectiveness. The number needed to treat to prevent RSVh using 5 and 6 dose regimen was 54.9 and 38, respectively, with a wide year-to-year variation from 25 to 166.6. RSVh cost without Palivizumab was $379,436; while palivizumab program cost for 5 and 6 dose were $727,481 and $849,888 respectively. Incremental cost-effective ratio per hospital admission prevented was $85,937 and $80,419 for 5 and 6 dose regimen, respectively, with a wide year-to-year variation from $40,410 to $277,367. Conclusion This is one of the first population-based studies in infants with HsCHD demonstrating a high RSVh burden in a region with round the year circulation of RSV. Palivizumab program was assessed to be not cost-effective in preventing RSVh in such a locality.

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Section: Discussionsupporting

confidence: 89%

Section: Cost Analysis and Potential E Cacy Of Palivizumab Programmentioning

confidence: 99%

Section: Cost Analysis and Potential E Cacy Of Palivizumab Programmentioning

confidence: 99%

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Population-based Respiratory Syncytial Virus Hospitalization Disease Burden and Cost Effectiveness of Palivizumab Prophylaxis in Infants with Hemodynamically Significant Congenital Heart Diseases

Chen

Chiu

Lee

et al. 2020

Preprint

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“…In a nationwide study, we found that that those with cyanotic CHD had higher RSV-related hospitalization rates and more severe disease than those with acyanotic CHD ( 11 ). We proposed a novel protocol for the use of palivizumab to prevent RSV infection in children with CHD who live in subtropical regions where RSV infections occur throughout the year and are not seasonally related ( 12 ). In brief, all patients with cyanotic CHD and hemodynamically significant (hs) acyanotic CHD aged younger than 1 year should receive monthly palivizumab prophylaxis for a maximum of 6 doses after the diagnosis of CHD if they fulfilled the criteria of hsCHD.…”

Section: Introductionmentioning

confidence: 99%

“…In brief, all patients with cyanotic CHD and hemodynamically significant (hs) acyanotic CHD aged younger than 1 year should receive monthly palivizumab prophylaxis for a maximum of 6 doses after the diagnosis of CHD if they fulfilled the criteria of hsCHD. The efficacy of this subtropical prophylaxis protocol has been validated by a multicenter study of patients living in a subtropical region ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Reappraisal of the Subtropical Guidelines on Palivizumab Prophylaxis in Congenital Heart Disease

et al. 2022

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Objective: To define the impact of associated abnormalities on the efficacy of the novel subtropical guidelines for palivizumab prophylaxis on respiratory syncytial virus (RSV)-related hospitalizations in patients with hemodynamically significant congenital heart disease (hsCHD).Method: This prospective study enrolled every patient seen at a tertiary care center for hsCHD, who was born between 2014 and 2018 and received at least 1 dose of palivizumab, according to the subtropical guidelines. The patients were followed until the age of 2 years.Results: A total of 772 patients (49% male) were enrolled. Cyanotic CHD was seen in 46% of patients, of whom 23% had associated abnormalities. Lung/airway abnormalities (14%) were the most common followed by the genetic syndromes associated with CHD (7.3%). Among the 772 patients, RSV-related hospitalizations occurred in 3.2 and 2.2% children aged ≤ 12 and 13–24 months, respectively. Most of the RSV infections occurred in patients no longer satisfying the criteria for palivizumab prophylaxis. The patients with associated abnormalities but not the type of CHD, patient age, and patient sex were risk factors for RSV-related hospitalizations. The rates of RSV-related hospitalizations, admission to the intensive care unit, and endotracheal intubation were higher for patients with associated anomalies than for other patients before 24 months of age (10.2 vs. 4.0%, 67 vs. 33%, and 39 vs. 4.2%, p = 0.004, 0.06, 0.013, respectively).Conclusion: Children with abnormalities, especially genetic syndromes and lung/airway problems associated with CHD, are at high risk for RSV-related hospitalization. Our current subtropical guidelines for palivizumab prophylaxis in patients with hsCHD, should be revised to include the results of this study.

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Respiratory Syncytial Virus

Rago,

D’Arrigo,

Osmani

et al. 2024

Advances in Pediatrics

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Efficacy of a Novel Palivizumab Prophylaxis Protocol for Respiratory Syncytial Virus Infection in Congenital Heart Disease: A Multicenter Study

Cited by 10 publications

References 24 publications

Population-based Respiratory Syncytial Virus Hospitalization Disease Burden and Cost Effectiveness of Palivizumab Prophylaxis in Infants with Hemodynamically Significant Congenital Heart Diseases

Population-based Respiratory Syncytial Virus Hospitalization Disease Burden and Cost Effectiveness of Palivizumab Prophylaxis in Infants with Hemodynamically Significant Congenital Heart Diseases

Reappraisal of the Subtropical Guidelines on Palivizumab Prophylaxis in Congenital Heart Disease

Respiratory Syncytial Virus

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