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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

Jonathan C. Levin 
1   Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
2   Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts
,
Andrew L. Beam
3   Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
,
Kathe P. Fox
4   Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
,
Lystra P. Hayden
2   Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts
5   Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
› Institutsangaben Funding This study was supported by National Heart, Lung, and Blood Institute K23 HL136851, U.S. and National Library of Medicine T15LM007092.
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Abstract

Objective Our objective was to compare rates of hospitalizations for respiratory illnesses in preterm and full-term (FT) children for 4 years before and after the 2014 update to the American Academy of Pediatrics (AAP) respiratory syncytial virus (RSV) immunoprophylaxis guidance, which restricted eligibility among infants born at 29 to 34 weeks in the first winter and all preterm infants in the second winter after neonatal discharge.

Study Design 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 4 years before and after the implementation of the 2014 palivizumab eligibility change. A FT 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 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. The 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 the cost of hospitalizations and the cost of palivizumab.

Conclusion Hospitalizations for RSV or respiratory illness did not increase, and cost savings were obtained after the implementation of the 2014 AAP palivizumab prophylaxis policy.

Key Points

  • Palivizumab use decreased among children born moderate preterm (29 to34 weeks) after the 2014 palivizuamb policy update.

  • There was no change in odds of hospitalization with respiratory syncitial virus or respiratory illness among preterm infants after the policy update when compared to before.

  • There were cost savings, when accounting for the cost of hospitalizations and the cost of palivizumab, after the policy update among children born moderate preterm.

Keywords

respiratory syncytial virus - palivizumab - bronchopulmonary dysplasia - chronic lung disease - Prematurity

Supplementary Material



Publikationsverlauf

Eingereicht: 28. Januar 2022

Angenommen: 03. Mai 2022

Accepted Manuscript online:
06. Mai 2022

Artikel online veröffentlicht:
25. August 2022

© 2022. Thieme. All rights reserved.

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