Effect of an In-Home Palivizumab Administration Program for Children with Medical Complexity.

Area of Science:

• Pediatric Pulmonology
• Infectious Diseases
• Healthcare Management

Background:

• In-home palivizumab (PH) administration shows promise for reducing RSV infections.
• PH may benefit children with medical complexity (CMC) by limiting exposure to healthcare-associated infections (HAIs).

Purpose of the Study:

• To evaluate the effectiveness of in-home palivizumab administration compared to clinic-based administration for CMC.
• To assess the impact on healthcare utilization, including face-to-face encounters and hospitalizations.

Main Methods:

• Prospective study of 41 children with CMC (<2 years) randomized to PH or clinic (PC) administration.
• Stratification by home ventilation; primary outcome: total face-to-face encounters; secondary outcomes: unscheduled visits and hospitalizations.
• Standard frequentist and Bayesian analyses were performed.

Main Results:

• The PH group (n=13) showed a significant decrease in total face-to-face encounters (4.5 vs. 8.8) and hospitalizations (0.3 vs. 1.25) compared to the PC group (n=28).
• Bayesian analysis indicated a 93% probability of benefit favoring fewer encounters with PH.
• Demographic factors and strata were well-matched between groups.

Conclusions:

• In-home palivizumab administration appears to reduce healthcare utilization in children with medical complexity.
• Home-based interventions minimizing healthcare facility exposure are promising strategies for CMC.