CC BY-NC-ND 4.0 · Am J Perinatol 2020; 37(02): 174-183
DOI: 10.1055/s-0039-1694008
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Leonard R. Krilov
1   Division of Pediatric Infectious Disease, Children's Medical Center, NYU Winthrop Hospital, Mineola, New York
Jaime Fergie
2   Department of Pediatric Infectious Disease, Driscoll Children's Hospital, Corpus Christi, Texas
Mitchell Goldstein
3   Division of Neonatal Medicine, Loma Linda University Children's Hospital, Loma Linda, California
Lance Brannman
4   AstraZeneca, Gaithersburg, Maryland
› Author Affiliations
Funding This study was supported by AstraZeneca (the manufacturer of palivizumab), which owned the U.S. rights to palivizumab at the time this work was completed. The U.S. rights to palivizumab are currently owned by Swedish Orphan Biovitrum AB.
Further Information

Publication History

17 January 2019

24 June 2019

Publication Date:
20 August 2019 (online)


Objective This study examined the rate, severity, and cost of respiratory syncytial virus (RSV) hospitalizations among preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after a 2014 change in the American Academy of Pediatrics policy for RSV immunoprophylaxis.

Study Design Preterm (29–34 wGA) and term infants born from July 2011 to March 2017 and aged < 6 months were identified in a U.S. commercial administrative claims database. RSV hospitalization (RSVH) rate ratios, severity, and costs were evaluated for the 2011 to 2014 and 2014 to 2017 RSV seasons. Postpolicy changes in RSVH risks for preterm versus term infants were assessed with difference-in-difference (DID) modeling to control for patient characteristics and temporal trends.

Results In the DID analysis, prematurity-associated RSVH risk was 55% greater in 2014 to 2017 versus 2011 to 2014 (relative risk = 1.55, 95% confidence interval: 1.10–2.17, p = 0.011). RSVH severity increased among preterm infants after 2014 and was highest among those aged < 3 months. Differences in mean RSVH costs for preterm infants in 2014 to 2017 versus 2011 to 2014 were not statistically significant.

Conclusion RSVH risk for preterm versus term infants increased after the policy change, confirming previous national analyses. RSVHs after the policy change were more severe, particularly among younger preterm infants.

Supplementary Material