Am J Perinatol
DOI: 10.1055/a-1845-2184
Original Article

Cost Savings Without Increased Risk of Respiratory Hospitalization for Preterm Children After the 2014 Palivizumab Policy Update

Hospitalizations and costs after 2014 Palivizumab Policy Update
1   Newborn and Pulmonary Medicine, Boston Children's Hospital, Boston, United States (Ringgold ID: RIN1862)
,
Andrew Beam
2   Department of Biomedical Informatics, Harvard Medical School, Boston, United States (Ringgold ID: RIN1811)
3   Department of Epidemiology, Harvard University Department of Epidemiology, Boston, United States (Ringgold ID: RIN189346)
,
Kathe P Fox
2   Department of Biomedical Informatics, Harvard Medical School, Boston, United States (Ringgold ID: RIN1811)
,
Lystra P Hayden
4   Pulmonary Medicine, Boston Children's Hospital, Boston, United States (Ringgold ID: RIN1862)
› Author Affiliations
Supported by: National Heart, Lung, and Blood Institute K23 HL136851
Supported by: U.S. National Library of Medicine T15LM007092

Objective: To compare rates of hospitalizations for respiratory illnesses in preterm and full-term children for four years before and after the 2014 update to the American Academy of Pediatrics (AAP) respiratory syncytial (RSV) immunoprophylaxis guidance, which restricted eligibility among infants born at 29-34 weeks in the first winter and all preterm infants in the second winter after neonatal discharge. Methods: We conducted pre-post and interrupted time series analyses on claims data from a commercial national managed care plan. We compared the number of RSV and all respiratory hospital admissions in the first and second RSV seasons after neonatal discharge among a cohort of preterm children, regardless of palivizumab status, in the four years before and after implementation of the 2014 palivizumab eligibility change. A full-term group was included for reference. Results: The cohort included 821 early preterm (EP) <29 weeks, 4,790 moderate preterm (MP) 29-34 weeks, and 130,782 full-term (FT) children. Palivizumab use after the policy update decreased among MP children in the first and second RSV seasons after neonatal discharge, without any change in the odds of hospitalization with RSV or respiratory illness. For the EP group there was no change in the rate of palivizumab or the odds of hospitalization with RSV or respiratory illness after the policy update. For the FT group there was a slight decrease in odds of hospitalization post-2014 after the policy update. Interrupted time series did not reveal any secular trends over time in hospitalization rates among preterm children. Following the policy change there were cost savings for MP children in the first and second RSV seasons, when accounting for cost of hospitalizations and cost of palivizumab. Conclusions: Hospitalizations for RSV or respiratory illness did not increase and cost savings were obtained after implementation of the 2014 AAP palivizumab prophylaxis policy.



Publication History

Received: 28 January 2022

Accepted after revision: 03 May 2022

Accepted Manuscript online:
06 May 2022

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