title: Evaluation of the Financial and Health Burden of Infants at Risk for Respiratory Syncytial Virus.
abstract: 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).
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  Longitudinal evaluation of financial and clinical outcomes is needed to determine the impact of the 2014 AAP revised regulatory guidelines.
authors.affiliation: Duke 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).
authors.forename: Stephanie McCallum
authors.initials: SM
authors.lastname: Blake
authors.forename: David
authors.initials: D
authors.lastname: Tanaka
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bendz
authors.forename: Suzanne
authors.initials: S
authors.lastname: Staebler
authors.forename: Debra
authors.initials: D
authors.lastname: Brandon
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000191:economics; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics* / Q000627:therapeutic use; D007231:Infant, Newborn; D007234:Infant, Premature; D000069455:Palivizumab / Q000191:economics* / Q000627:therapeutic use; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy / Q000191:economics*; D012136:Respiratory Syncytial Viruses; D012189:Retrospective Studies
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; C098685:respiratory syncytial virus immune globulin intravenous; D000069455:Palivizumab