Respiratory syncytial virus hospitalization outcomes and costs of full-term and preterm infants

Abstract

Objective:Infection with respiratory syncytial virus (RSV), which causes lower respiratory tract infections, is the leading cause of hospitalization among children <1 year old in the United States. Risk factors for RSV hospitalization include premature birth and younger chronologic age, along with several comorbid conditions. However, in terms of RSV hospitalization costs, premature infants are rarely studied separately from full-term infants. The objective of this study is to describe the cost and severity of RSV hospitalizations among preterm and full-term infants without chronic lung disease or other high-risk conditions.Study Design:This analysis used Truven Health Market Scan Multi-State Medicaid and Commercial Claims and Encounters databases, which contain a combined 4 million births from 2003 to 2013. Infants with comorbid conditions associated with increased risk for RSV infection were excluded. Infants were classified as preterm (<29, 29−30, 31−32, 33−34 and 35−36 weeks' gestational age (wGA)) or full term based on diagnostic coding. Health-care claims during the first year of life were evaluated for RSV hospitalizations, defined as inpatient claims with a diagnosis code for RSV in any position. Costs of RSV hospitalizations were captured and reported in 2014 USD. Inpatient claims for RSV hospitalizations were evaluated for the presence of codes indicating admission to the intensive care unit (ICU), use of mechanical ventilation (MV) and length of stay. These three measures were used to describe hospital severity. Chronologic age at the time of RSV hospitalization was also captured. Data were summarized and no statistical comparisons were conducted.Results:There were 1 683 188 infants insured through Medicaid and 1 663 832 infants insured through commercial plans born from 1 July 2003 to 30 June 2013. Of those, 10.8 and 8.8% in each database, respectively, were born prematurely. There were 29 967 Medicaid-insured infants and 16 310 commercially insured infants with an RSV hospitalization during their first year of life. Mean first-year RSV hospitalization costs were higher for preterm infants, ranging from $8324 and $10 570 for full-term infants to $15 839 and $19 931 for preterm infants 33–34 wGA, and to $39 354 and $40 813 for preterm infants <29 wGA, among Medicaid-insured and commercially insured infants, respectively. RSV hospitalizations also tended to be more severe among preterm infants, with longer lengths of stay, a higher proportion of infants admitted to the intensive care unit (ICU) and increased use of MV compared with full-term infants. Mean costs of RSV hospitalizations with a PICU admission ranged from approximately $35 000 to $89 000. In both Medicaid and commercial groups, costs were greater for infants hospitalized at <90 days of age compared with older infants.Conclusions:Infants who were born prematurely and those hospitalized at <90 days of age have more costly and more severe RSV hospitalizations during the first year of life. These findings demonstrate important differences in th...

Valganciclovir Use Among Commercially and Medicaid-insured Infants With Congenital CMV Infection in the United States, 2009–2015

“…The prevalence of congenital CMV disease was higher among infants with Medicaid insurance (3.3 per 10,000) compared to commercially-insured infants (2.5 per 10,000), which likely reflects a higher proportion of Medicaid infants with underlying conditions and risk factors associated with congenital CMV infection, such as non-White race, or other maternal characteristics, such as age or socioeconomic status, that could not be measured 15 . A study that looked at RSV hospitalizations among commercially and Medicaid insured infants also found higher rates of hospitalizations and more severe cases among Medicaid-insured infants 16 . Data from this study and others suggest that not all infants with symptomatic congenital CMV disease are diagnosed or captured using administrative healthcare claims 17, 18 .…”

Palivizumab Prophylaxis for Respiratory Syncytial Virus: Examining the Evidence Around Value

“…First, RSV hospitalization costs vary by patient gestational and chronologic age, with younger and more premature infants more likely to have more expensive longer stays and higher use of ICUs [11]. Second, the cost of palivizumab prophylaxis is based on infant weight, which is determined partly by the gestational age at birth, as well as the chronologic age.…”

“…The cost of immunoprophylaxis varies, as the dose is weight dependent. A single course of palivizumab is estimated to range from $1500 to $4300 per month, costing as much as $6000 to $20 000 per child for 4 to 5 doses in 1 RSV season [10, 11]. A significant portion of the children receiving immunoprophylaxis are covered by state Medicaid plans [12], although eligibility criteria for coverage vary from state to state.…”

Surviving Deadly Lung Infections: Innate Host Tolerance Mechanisms in the Pulmonary System

“…It leads to an estimated 500,000 deaths annually, in addition to the hospitalizations and loss of productivity from infected people (17). There are also a variety of other viruses that can infect the lower respiratory tract and lead to pneumonia, including respiratory syncytial virus (RSV), parainfluenza, human metapneumonia, and some adenoviruses (14,(18)(19)(20)(21)(22). Rhinoviruses and newly described coronaviruses also infect the respiratory tract and cause disease.…”

“…Rhinoviruses and newly described coronaviruses also infect the respiratory tract and cause disease. RSV, in particular, can cause complications in young children and is the leading cause of hospitalization in children less than one year old in the United States (18). Many of these respiratory viruses spread easily from person to person, or can be spread from an animal reservoir (23).…”