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Hospitalization and Economic Implications of Prophylaxis

Timothy P. Stevens, MD; Robert A. Sinkin, MD; Caroline B. Hall, MD; William M. Maniscalco, MD; Kenneth M. McConnochie, MD, MPH

Arch Pediatr Adolesc Med. 2000;154:55-61.

Objectives  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.

Design  Historical cohort study.

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

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

Main Outcome Measures  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 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 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.

From the Divisions of Neonatology (Drs Stevens, Sinkin, and Maniscalco), Infectious Diseases (Dr Hall), and General Pediatrics (Dr McConnochie), Children's Hospital at Strong, University of Rochester, Rochester, NY.

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