Respiratory Syncytial Virus Hospitalizations among U.S. Preterm Infants Compared with Term Infants Before and After the 2014 American Academy of Pediatrics Guidance on Immunoprophylaxis: 2012–2016

Abstract

Objective The objective of this study was to compare risk for respiratory syncytial virus (RSV) hospitalizations (RSVH) for preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after 2014 guidance changes for immunoprophylaxis (IP), using data from the 2012 to 2016 RSV seasons. Study Design Using commercial and Medicaid claims databases, infants born between July 1, 2011 and June 30, 2016 were categorized as preterm or term. RSVH during the RSV season (November–March) were identified for infants aged <6 months and rate ratios (RRs) for hospitalization comparing preterm and term infants were calculated. Difference-in-difference models were fit to evaluate the changes in hospitalization risks in preterm versus term infants from 2012 to 2014 seasons to 2014 to 2016 seasons. Results In all seasons, preterm infants had higher RSVH rates than term infants. Seasonal RRs prior to the guidance change for preterm wGA categories versus term infants ranged from 1.6 to 3.4. After the guidance change, the seasonal RRs ranged from 2.6 to 5.6. In 2014 to 2016, the risk associated with prematurity of 29 to 34 wGA versus term was significantly higher than in 2012 to 2014 ( P <0.0001 for commercial and Medicaid samples). Conclusion In infants aged <6 months, the risk for RSVH for infants 29 to 34 wGA compared with term infants increased significantly after the RSV IP recommendations became more restrictive.

Impact of the 2014 American Academy of Pediatrics Immunoprophylaxis Policy on the Rate, Severity, and Cost of Respiratory Syncytial Virus Hospitalizations among Preterm Infants

“…Our results are in line with those of previous analyses that found substantially decreased outpatient RSV IP use and increased RSVH risk among preterm infants after the AAP policy change. 9,[20][21][22] In single-center studies by Rajah et al and Blake et al, RSVH rates for preterm infants were significantly greater in post-versus pre-policy change RSV seasons. 9,21 Similarly, administrative claims analyses utilizing a patient population comparable to ours from the Truven Health MarketScan database showed that RSVH risk among preterm infants increased significantly in the 2014 to 2015 season compared with the 2013 to 2014 season, 20 and in the 2014 to 2016 seasons compared with the 2012 to 2014 seasons.…”

“…Several U.S. studies have demonstrated an increase in RSVH risk among infants 29 to 34 wGA and < 6 months CA under the more restrictive recommendations. 9,[20][21][22] These findings would benefit from validation in other large datasets. In addition, the effect of the policy change on RSVH severity and costs has not been evaluated.…”

SENTINEL1: Two-Season Study of Respiratory Syncytial Virus Hospitalizations among U.S. Infants Born at 29 to 35 Weeks' Gestational Age Not Receiving Immunoprophylaxis

“…Additionally, three recent studies demonstrate the rate of RSVH in infants 29 to 34 wGA compared with term infants has increased since the release of the 2014 COID guidance. 27,29,30 Another limitation of this study is that although hospital charges are reported, actual reimbursement amounts may differ. Hospital charges reported here do not include physician fees and also do not account for reimbursements that are commonly negotiated between hospitals and insurance carriers.…”

“…[21][22][23] Historically, the COID guidance recognized that preterm infants 29 to 35 wGA were at high enough risk to warrant RSV IP in certain circumstances that varied among iterations of the guidance. 98 (28) 99 (30) 197 2925 (13) 19 (10) 44 126 67 813 75 96 1111 (10) Abbreviations COID guidance statement, released in 2014, was the first to not recommend RSV IP for infants who were born at 29 to 35 wGA without comorbidities.…”

Recent Trends in RSV Immunoprophylaxis: Clinical Implications for the Infant

“…11 Two recent large retrospective studies using commercial and Medicaid insurance databases compared RSV hospitalization rates in premature infants before and after the 2014 AAP guidance change, and included healthy full-term infants as a reference. 12,13 Authors showed again that RSV-associated hospitalizations in infants born at 29 to 34 wGA and < 3 months of age increased up to 2.7-fold after the guidance change. They also showed that compared with fullterm infants, premature infants had up to seven times higher risk for RSV-associated hospitalizations.…”