RSV Immunoprophylaxis: Does the Benefit Justify the Cost?

Meissner, H. Cody; Kimberlin, David W.

doi:10.1542/peds.2013-2449

Cited by 34 publications

(33 citation statements)

References 23 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…8 The authors report the mean among children with 'no high-risk condition,' which incorporated children born prematurely and those with other comorbid conditions ($8099), but they do not report estimates for premature infants or those who have other significant risk factors for RSV. 7 Although an approximation of $8000 has been used as an estimate for the cost of an RSV hospitalization in prophylaxis cost-effectiveness calculations, 9 this figure is not specific to hospitalizations for RSV, and its use for that purpose is therefore inaccurate. The estimated costs used in such calculations should be specific to gestational age and health condition.…”

Section: Discussionmentioning

confidence: 99%

“…For example, a recent study that summarized trends in bronchiolitis hospitalizations reported an average cost of $8530. 8 Other researchers have assumed that this figure was applicable to all palivizumab-eligible infant populations, 9 when in fact this is the average cost of hospitalizations for infants <2 years of age with bronchiolitis, and is neither specific to RSV nor to high-risk infants. Summary statistics such as this are unlikely to accurately reflect the experience of high-risk infants, who represent a small proportion of the total infant population.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2016

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

View full text Add to dashboard Cite

show abstract

“…(49, 50) However, in the lower risk groups (for whom prophylaxis continues to be given), the number-needed-to-treat (NNT) is in the range of 19-170, conferring an unfavorable cost:benefit ratio given the high cost of the drug. (51) Whether palivizumab prevents future wheezing episodes, as suggested by relatively preliminary data from two industry sponsored trial, (52, 53) remains unproven. Clearly, the causal relationship between RSV or other viruses and the future development of asthma requires ongoing investigation.…”

Section: Therapeuticsmentioning

confidence: 99%

Recent evidence on the management of bronchiolitis

Schroeder

Mansbach²

2014

Current Opinion in Pediatrics

View full text Add to dashboard Cite

Purpose of Review Bronchiolitis is a common condition in children < 2 years and is a leading cause of infant hospitalization. While there is significant variability in testing and treatment of children with bronchiolitis, diagnostic testing rarely improves care, and no currently available pharmacologic options have been proven to provide meaningful benefit or improve outcomes. Recent Findings Beta-agonists continue to be used frequently despite evidence that they do not reduce hospital admissions or length-of-stay. In general, therapies initially considered promising were subsequently proven ineffective, a pattern seen in studies on corticosteroids, and more recently with nebulized racemic epinephrine and hypertonic saline. Recent research has improved our understanding of the viral epidemiology of bronchiolitis, with increasing recognition of viruses other than respiratory syncytial virus and better awareness of the role of viral co-infections. How these findings will translate into improved outcomes remains uncertain. Summary Much of the emphasis of the last few decades of bronchiolitis clinical care and research has centered on the identification and testing of novel therapies. Future quality improvement efforts should focus more on the limitation of unnecessary testing and treatments. Future research should include identification of subgroups of children with bronchiolitis that may benefit from focused clinical interventions.

show abstract

“…4 As noted by others, 12 the cost of palivizumab administration was high at both the infant and population level , and the effect of palivizumab was limited. The 29-to 32-week preterm infants had a difference in hospitalization rates of 1.9% between infants who did or did not receive palivizumab.…”

mentioning

confidence: 83%

Palivizumab Prophylaxis for Healthy Preterm Infants: More Data Supporting American Academy of Pediatrics Guidelines

Byington

2016

Pediatrics

View full text Add to dashboard Cite

RSV Immunoprophylaxis: Does the Benefit Justify the Cost?

Cited by 34 publications

References 23 publications

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

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

Recent evidence on the management of bronchiolitis

Palivizumab Prophylaxis for Healthy Preterm Infants: More Data Supporting American Academy of Pediatrics Guidelines

Contact Info

Product

Resources

About