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An Improved and High Throughput Respiratory Syncytial Virus RSV Micro-neutralization Assay
Published on: January 26, 2019
Evaluation of the Financial and Health Burden of Infants at Risk for Respiratory Syncytial Virus
Stephanie McCallum Blake1, David Tanaka, Lisa M Bendz
1Duke University School of Nursing and Department of Pediatrics, Duke University School of Medicine (Dr Brandon), Duke University Medical Center (Drs Blake, Tanaka, and Bendz), Durham, North Carolina; and Nell Hodgson Woodruff School of Nursing at Emory University, Atlanta, Georgia (Dr Staebler).
Insights
The American Academy of Pediatrics
Area of Science:
- Pediatrics
- Infectious Diseases
- Health Economics
Background:
- Respiratory syncytial virus (RSV) is a leading cause of infant mortality.
- The American Academy of Pediatrics (AAP) revised palivizumab (Synagis) prophylaxis guidelines in 2014 due to limited clinical benefit and high costs.
- The revised guidelines impacted infants born at >29 weeks gestation.
Purpose of the Study:
- To evaluate the impact of the revised AAP palivizumab prophylaxis guidelines on infant health outcomes and hospital costs.
- Focus on infants born between 29 and <32 weeks gestation.
Main Methods:
- Retrospective cohort analysis comparing infants before (PRE) and after (POST) the 2014 AAP guideline changes.
- Analysis of clinical and financial outcomes from a single institution.
Main Results:
- RSV-positive admissions increased in the POST cohort compared to the PRE cohort (P = .04).
- No deaths from RSV readmission occurred in either cohort.
- The number needed to treat to prevent one RSV hospitalization was 20 infants, with palivizumab costs ($90,000) exceeding avoided hospital costs ($29,000).
Conclusions:
- Individual risk factor assessment may improve prophylaxis decisions for RSV.
- Further longitudinal studies are needed to fully understand the impact of the 2014 AAP guidelines on clinical and financial outcomes.
Background:
Respiratory syncytial virus (RSV) is the leading viral cause of death in infants younger than 1 year. In July 2014, the American Academy of Pediatrics (AAP) Committee on Infectious Diseases concluded that the "limited clinical benefit" for infants born at more than 29 weeks' gestation, together with the associated high cost of the immunoprophylaxis, no longer supported the routine use of palivizumab (Synagis).
Purpose:
To evaluate the impact of the newly adopted AAP palivizumab prophylaxis administration on health and subsequent hospital costs of infants born between 29 and less than 32 weeks' gestation.
Methods:
A retrospective cohort analysis from a single institution across the duration of the study comparing the clinical and financial outcomes of infants (aged < 32 weeks) treated under the 2009 AAP guidelines (PRE) and infants (aged >29 weeks) managed after the 2014 AAP guidelines (POST) took effect.
Results:
RSV-positive admissions were greater in the POST cohort versus the PRE cohort (P = .04). There were no readmission deaths due to RSV infection in either cohort. The number needed to treat to avoid a single RSV-positive hospitalization was 20 infants at an estimated palivizumab cost of $90,000 to avoid an estimated hospital cost of $29,000.
Implications For Practice:
Assessment of individual risk factors and their ability to predict severe RSV risk/disease, thus, would allow providers greater flexibility in determining need for prophylaxis therapy.
Implications For Research:
Longitudinal evaluation of financial and clinical outcomes is needed to determine the impact of the 2014 AAP revised regulatory guidelines.
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