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.

Limitations:

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.

Key words::

• Costs and cost analysis
• Healthcare use
• Medicaid
• Respiratory syncytial virus infection

Transparency

Declaration of funding

This study was funded by MedImmune, LLC, Gaithersburg, MD, USA.

Declaration of financial/other relationships

N.S., L.P., and B.-C. C. have disclosed that they are employees of Thomson Reuters and provide custom consulting services to all major pharmaceutical companies as a condition of employment. As part of a consulting agreement with Thomson Reuters, MedImmune provided funding to Thomson Reuters to support the data collection, analysis, and manuscript development activities associated with this manuscript. C.B.H. and J.P.K. have served as consultants for MedImmune. A.S.M. and P.J.M. have disclosed that they are employees of MedImmune.

Acknowledgments

The authors wish to acknowledge the contributions of Robert Sedgley, who served as the primary SAS programmer. We would also like to thank Kimmie McLaurin for her assistance during the study design phase. Formatting and editorial assistance was provided by Complete Healthcare Communications, Inc. (Chadds Ford, PA, USA) and funded by MedImmune.