title: Association of RSV lower respiratory tract infection and subsequent healthcare use and costs: a Medicaid claims analysis in early-preterm, late-preterm, and full-term infants.
abstract: OBJECTIVE
  Healthcare use and costs within 1 year of a respiratory syncytial virus lower respiratory tract infection (RSV-LRI) among Medicaid early-preterm and late-preterm infants compared with full-term infants were evaluated.
  
  
  METHODS
  Infants born during 2003-2005 were identified from the Thomson Reuters MarketScan Multi-State Medicaid Database. Infants <1 year of age were grouped based on RSV-LRI and unspecified bronchiolitis/pneumonia (UBP) diagnosis codes and stratified by inpatient or outpatient setting. Infants without RSV-LRI/UBP were selected for comparison. Economic and clinical outcomes were analyzed descriptively; the relationship between RSV-LRI/UBP and costs incurred within 1 year of infection were analyzed using logged ordinary least squares models. Results were stratified by gestational age.
  
  
  RESULTS
  Most infants were diagnosed with RSV-LRI/UBP after 90 days of chronologic age. Early-preterm infants had the greatest mean number of inpatient, outpatient, and emergency department visits after an RSV-LRI/UBP episode. The marginal costs among infants with RSV-LRI compared with controls were $34,132 (p < 0.001) and $3869 (p = 0.115) among inpatients and outpatients, respectively. Among late-preterm infants, the marginal costs were $17,465 (p < 0.001) and $2158 (p < 0.001) among inpatients and outpatients, respectively. Full-term infants had the lowest marginal costs (inpatients, $9151 [p < 0.001]; outpatients, $1428 [p < 0.001]). Overall, inpatient infants with RSV-LRI/UBP had higher costs than outpatients, suggesting that increased downstream costs are associated with severity of RSV-LRI/UBP disease.
  
  
  CONCLUSIONS
  Infants with unknown etiology for bronchiolitis were assigned to the UBP group, which may underestimate the costs of the comparison group.
  
  
  CONCLUSIONS
  The burden of RSV-LRI was substantial among early-preterm Medicaid infants. Costs were also higher among late-preterm relative to full-term infants.
authors.affiliation: Thomson Reuters, Outcomes Research, Cambridge, MA, USA.
authors.forename: Nianwen
authors.initials: N
authors.lastname: Shi
authors.forename: Liisa
authors.initials: L
authors.lastname: Palmer
authors.forename: Bong-Chul
authors.initials: BC
authors.lastname: Chu
authors.forename: Julie P
authors.initials: JP
authors.lastname: Katkin
authors.forename: Caroline B
authors.initials: CB
authors.lastname: Hall
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Masaquel
authors.forename: Parthiv J
authors.initials: PJ
authors.lastname: Mahadevia
mesh_terms: D015331:Cohort Studies; D019992:Databases as Topic; D005260:Female; D005102:Health Expenditures / Q000639:trends*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007345:Insurance Claim Review; D008297:Male; D008484:Medicaid / Q000191:economics*; D008485:Medical Audit; D047928:Premature Birth; D018357:Respiratory Syncytial Virus Infections / Q000191:economics*; D012141:Respiratory Tract Infections / Q000191:economics*; D012189:Retrospective Studies; D014481:United States