Health care utilisation of prematurely born, preschool children related to hospitalisation for RSV infection

Greenough, Anne; Alexander, John R.; Burgess, S; Bytham, J; Chetcuti, Philip; Hagan, Joseph; Lenney, Warren; Melville, Sharon K.; Shaw, N J; Boorman, J; Coles, Stephen J.; Turner, Jackie; Pang, F

doi:10.1136/adc.2003.036129

Cited by 113 publications

(81 citation statements)

References 7 publications

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“…RSV infection is the commonest cause of hospitalization in children aged <1 year [3], and it causes more severe disease in high-risk infants. Early data suggest a possible association between RSV infection in children with chronic lung disease who were born prematurely, and chronic respiratory morbidity [4]. The UK Joint Committee on Vaccination and Immunisation advises that the RSV-monoclonal antibody, palivizumab, should be offered prophylactically to babies under 2 years of age with severe chronic lung disease, who are on home oxygen during the RSV season and on a case-bycase basis for babies with rare conditions such as multiple congenital abnormalities or severe immunodeficiency [5].…”

Section: Discussionmentioning

confidence: 99%

Timing of monoclonal antibody for seasonal RSV prophylaxis in the United Kingdom

Nl¹,

Cooke²,

Rk³

et al. 2006

Epidemiol. Infect.

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SUMMARYRespiratory syncytial virus (RSV) infection produces more severe disease and increased hospitalization rates in high-risk babies. The monoclonal antibody palivizumab offers protection against complications, and the first of five monthly doses should be administered before the onset of community RSV activity. However, the required real-time prediction of this onset is problematic. We attempted to identify seasonal RSV patterns by retrospectively examining 10 years of laboratory reports for RSV and clinical episode reports for certain respiratory presentations in both primary and secondary care. Analysis of hospital laboratory reports, incidence of acute bronchitis in primary care, and hospital admissions for acute bronchitis and bronchiolitis in young children revealed a consistent increase in RSV activity during week 43 each year. Promptly commencing prophylaxis during the second week of each October (week 42) would precede the onset of the RSV season in the United Kingdom, and provide coverage until its decline in mid-March.Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection in young children ; its manifestations include bronchiolitis in infants/young children, and acute bronchitis in older children [1,2]. Approximately 80 % of children are infected by 2 years of age, but re-infection can occur throughout life. RSV infection is the commonest cause of hospitalization in children aged <1 year [3], and it causes more severe disease in high-risk infants. Early data suggest a possible association between RSV infection in children with chronic lung disease who were born prematurely, and chronic respiratory morbidity [4]. The UK Joint Committee on Vaccination and Immunisation advises that the RSV-monoclonal antibody, palivizumab, should be offered prophylactically to babies under 2 years of age with severe chronic lung disease, who are on home oxygen during the RSV season and on a case-bycase basis for babies with rare conditions such as multiple congenital abnormalities or severe immunodeficiency [5].Thresholds for community influenza activity are used to trigger the use of neuraminidase inhibitors in high-risk patients [6,7], although the intervention of choice in these patients remains prevention through vaccination. In contrast, RSV activity cannot be employed in the same way to trigger the use of palivizumab. Laboratory data are subject to reporting delays, and therefore cannot be used for real-time decision making. In addition, the first dose of palivizumab should be given prior to the onset of RSV activity and there are limited data to support its use beyond five doses at monthly intervals. Thus, waiting until laboratory data indicate that RSV is circulating risks starting therapy too late ; conversely, starting therapy too far in advance of RSV activity risks giving This retrospective study aimed to identify patterns in seasonal RSV activity by examining 10 years of laboratory data on RSV isolations, the incidence of acute bronchitis in primary care, and hospi...

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Section: Discussionmentioning

confidence: 99%

Timing of monoclonal antibody for seasonal RSV prophylaxis in the United Kingdom

Nl¹,

Cooke²,

Rk³

et al. 2006

Epidemiol. Infect.

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“…Two papers present an assessment of quality of life after RSVrelated hospital discharge [22,26]. One paper presents actual QALY scores [26].…”

Section: Utilities (Qalys)mentioning

confidence: 99%

“…One paper presents actual QALY scores [26]. In this study, quality-of-life in children, aged 2-4 years, with a history of preterm birth and RSV-hospitalization were compared with a control group of preterm children without a history of RSV-hospitalization.…”

Section: Utilities (Qalys)mentioning

confidence: 99%

Cost-effectiveness of potential infant vaccination against respiratory syncytial virus infection in The Netherlands

Meijboom

Rozenbaum²,

Benedictus

et al. 2012

Vaccine

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Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. t r a c tIntroduction: Respiratory syncytial virus (RSV) infection is one of the major causes of respiratory illness in infants, infecting virtually every child before the age of 2 years. Currently, several Phase 1 trials with RSV vaccines in infants are ongoing or have been completed. As yet, no efficacy estimates are available for these vaccine candidates. Nevertheless, cost-effectiveness estimates might be informative to enable preliminary positioning of an RSV vaccine. Methods: A decision analysis model was developed in which a Dutch birth cohort was followed for 12 months. A number of potential vaccination strategies were reviewed such as vaccination at specific ages, a two-or three-dosing scheme and seasonal vaccination versus year-round vaccination. The impact of the assumptions made was explored in various sensitivity analyses, including probabilistic analysis. Outcome measures included the number of GP visits, hospitalizations and deaths, costs, quality-adjusted life years and incremental cost-effectiveness ratios (ICERs). Results: Currently, without vaccination, an annual number of 28,738 of RSV-related GP visits, 1623 hospitalizations, and 4.5 deaths are estimated in children in the age of 0-1 year. The total annual cost to society of RSV in the non-vaccination scenario is D 7.7 million (95%CI: 1.7-16.7) and the annual disease burden is estimated at 597 QALYs (95%CI: 133-1319). In case all infants would be offered a potentially safe and effective 3-dose RSV vaccination scheme at the age of 0, 1 and 3 months, the total annual net costs were estimated to increase to D 21.2 million, but 544 hospitalizations and 1.5 deaths would be averted. The ICER was estimated at D 34,142 (95%CI: D 21,652-D 87,766) per QALY gained. A reduced dose schedule, seasonal vaccination, and consideration of out-of-pocket expenses all resulted in more favorable ICER values, whereas a reduced vaccine efficacy or a delay in the timing of vaccination resulted in less favorable ICERs. Discussion: Our model used recently updated estimates on the burden of RSV disease in children and it included plausible utilities. However, due to the absence of clinical trial data, a number of crucial assumptions had to be made related to the characteristics of potential RSV vaccine. The outcomes of our modeling exercise show that vaccination of infants against RSV might be cost-effective. However, clinical trial data are warranted.

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“…The study by Greenough et al 26 assessed the health-related quality of life (HRQoL) for preterm children at the age of 5 years using the Health Utilities Index (HUI). The HUI described a family of genetic health status and HRQoL measures.…”

Section: Utilitiesmentioning

confidence: 99%

Palivizumab for immunoprophylaxis of respiratory syncitial virus (RSV) bronchiolitis in high-risk infants and young children: a systematic review and additional economic modelling of subgroup analyses

Wang¹,

Bayliss²,

Meads³

2011

Health Technol Assess

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Health care utilisation of prematurely born, preschool children related to hospitalisation for RSV infection

Cited by 113 publications

References 7 publications

Timing of monoclonal antibody for seasonal RSV prophylaxis in the United Kingdom

Timing of monoclonal antibody for seasonal RSV prophylaxis in the United Kingdom

Cost-effectiveness of potential infant vaccination against respiratory syncytial virus infection in The Netherlands

Palivizumab for immunoprophylaxis of respiratory syncitial virus (RSV) bronchiolitis in high-risk infants and young children: a systematic review and additional economic modelling of subgroup analyses

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