Respiratory outcomes, utilization and costs 12 months following a respiratory syncytial virus diagnosis among commercially insured late-preterm infants

Abstract

Objectives:

To determine, among a commercially-insured population of late-preterm infants, utilization of healthcare resources and costs during the 1 year following a diagnosis of respiratory syncytial virus lower respiratory infection (RSV LRI).

Methods:

Administrative claims for non-capitated, commercially-insured infants <1 year old were used to identify infants diagnosed with RSV LRI and unspecified bronchiolitis/pneumonia (UBP). Infants were stratified by the setting of diagnosis. Infants without evidence of RSV LRI or UBP were selected as a comparison group. Economic and clinical outcomes were analyzed descriptively using propensity score weighting and logged ordinary least squares models were used to examine the relationship between RSV and costs (adjusted to 2006 USD) incurred within 1 year of RSV LRI.

Results:

The majority of infants were 3 months or older at the time of RSV LRI or UBP diagnosis. The rate of wheezing was significantly greater for infants in the RSV LRI and UBP cohorts relative to the comparison group (p < 0.001). Infantile asthma rates were 6–9 times higher among RSV LRI and UBP infants than the comparison group. RSV LRI and UBP infants also had significantly more emergency department visits and outpatient visits than the comparison group. The marginal healthcare costs were significantly higher for RSV LRI inpatients ($24 027) and outpatients ($2703) infants than for the comparison group (all p < 0.001).

Conclusion:

Commercially insured late-preterm infants with RSV infection are at high risk for recurrent wheezing and infantile asthma during the 1-year period after the initial episode and impose a significant economic burden to the healthcare system.

Key words::

• Costs and cost analysis
• Respiratory syncytial virus infection
• Utilization
• Wheezing

Transparency

Declaration of funding

The study was sponsored by MedImmune, LLC. The analysis for this study was conducted primarily at Thomson Reuters, which provides custom consulting services to all major pharmaceutical companies. As part of a consulting agreement with Thomson Reuters, MedImmune provided funding to the company to support protocol development, data analysis and manuscript development activities associated with this study.

Declaration of financial/other relationships

L.P. and N.S. have served as consultants to MedImmune as employees of Thomson Reuters. C.B.H. and J.P.K. have disclosed that they have served as consultant/medical advisory board members to MedImmune. C.B.H. has disclosed that she has received research support at one site of a multicenter study sponsored by MedImmune. A.S.M., K.K.M., and P.J.M. are employees of MedImmune.

Acknowledgments

The authors acknowledge the contributions of Robert Sedgley, who served as the primary SAS programmer, and Bong-Chul Chu, PhD, who provided statistical support for the propensity score matching and multivariate modeling for the study. Susan DeRocco, PhD and Gerard P. Johnson, PhD of Complete Healthcare Communications, Inc. (Chadds Ford, PA), assisted with editing and formatting this manuscript, which was funded by MedImmune.

This study was presented at the American Academy of Pediatrics National Conference & Exhibition, Washington, DC, October 17–19, 2009.