Respiratory syncytial virus and premature infants born at 32 weeks' gestation or earlier: hospitalization and economic implications of prophylaxis.
OBJECTIVE
To assess the risk of hospitalization associated with respiratory syncytial virus (RSV) and to estimate the economic impact of RSV prophylaxis with either RSV immune globulin (RSV-Ig) or RSV monoclonal antibody (palivizumab) on a cohort of preterm infants born at 32 weeks' gestation or earlier.


METHODS
Historical cohort study.


METHODS
A 12-county neonatal network served by the regional center in Rochester, NY.


METHODS
One thousand twenty-nine infants born at 32 weeks' gestation or earlier followed up until 1 year of corrected age.


METHODS
Rate of hospitalization with an RSV-associated illness; cost per hospitalization prevented resulting from either form of RSV prophylaxis.


RESULTS
The probability of hospitalization with an RSV-associated illness for infants born at 32 weeks' gestation or earlier was estimated at 11.2%. The incidence of RSV hospitalization increased with decreasing gestational age (13.9% vs 4.4% for infants born at < or =26 weeks' gestation vs those born at 30-32 weeks' gestation). Infants requiring respiratory support at 36 weeks of postconceptual age (PCA) or older had a higher hospitalization rate (16.8% vs 6.2%), longer hospital stays, and higher hospital charges than infants requiring respiratory support at less than 36 weeks of PCA. For infants requiring respiratory support at less than 36 weeks of PCA, the incidence of RSV hospitalization still increased with decreasing gestational age (10.2% vs 4.3% for infants < or =26 weeks' gestation vs those 30-32 weeks' gestation). Analysis indicated that both forms of RSV prophylaxis would increase the net cost of care for all groups. Palivizumab was more cost-effective than RSV-Ig for preventing RSV hospitalization among infants who required respiratory support at less than 36 weeks of PCA, especially those born at 26 weeks' gestation or earlier. Overall, RSV-Ig was more cost-effective than palivizumab for infants requiring respiratory support at 36 weeks of PCA or older.


CONCLUSIONS
This analysis suggests that available forms of RSV prophylaxis would increase the net cost of care not only for the entire cohort but for each of the subgroups studied. However, the RSV hospitalization rate and the cost-effectiveness of prophylaxis varied markedly by subgroup.
Stevens
T P
TP
Division of Neonatology, Children's Hospital at Strong University of Rochester, NY, USA. bowlesroad@msn.com
Sinkin
R A
RA
Hall
C B
CB
Maniscalco
W M
WM
McConnochie
K M
KM
D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D000069455:Palivizumab; D018357:Respiratory Syncytial Virus Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D012136:Respiratory Syncytial Viruses
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D016756:Immunoglobulins, Intravenous; C098685:respiratory syncytial virus immune globulin intravenous; D000069455:Palivizumab