RSV-related hospitalization and outpatient palivizumab use in very preterm (born at <29 wGA) infants: 2003-2020

Figures & data

Table 1. Number of infants and infant-seasons contributed by palivizumab use and payer.

	Commercial		Medicaid
Gestational Age Cohort	Infants	Infant-Seasons	Infants	Infant-Seasons
All infants
Term (37+ weeks)	1,925,658	1,745,600.9	2,496,284	2,358,873.1
Very Preterm Infants (<29 weeks)	13,094	9630.5	27,029	20,346.1
27–28 weeks	7,368	5564.8	14,678	11,445.3
25–26 weeks	3,919	2779.3	8,424	6,135.3
<25 weeks	1,807	1286.4	3,927	2,765.5
With Palivizumab
Term (37+ weeks)	672	626.5	1,238	1,193.0
Very Preterm Infants (<29 weeks)	7,740	5,853.6	15,978	12,701.3
27–28 weeks	4,510	3,493.4	8,867	7,218.9
25–26 weeks	2,356	1,720.7	5,062	3,963.9
<25 weeks	874	639.5	2,049	1,518.5
Without Palivizumab
Term (37+ weeks)	1,924,986	1,744,974.4	2,495,046	2,357,680.2
Very Preterm Infants (<29 weeks Gestational Age)	5,354	3,776.8	11,051	7,644.8
27–28 weeks	2,858	2,071.4	5,811	4,226.4
25–26 weeks	1,563	1,058.5	3,362	2,171.4
<25 weeks	933	647.0	1,878	1,247.0

Table 2. Infant demographic characteristics of term and very preterm infants by palivizumab use and payer.

	Commercial				Medicaid
	Term		Very Preterm		Term		Very Preterm
	PAL N = 672	No PAL N = 1,924,986	PAL N = 7,740	No PAL N = 5,354	PAL N = 1,238	No PAL N = 2,495,046	PAL N = 15,978	No Pali N = 11,054
Sex
Male	56.8%	49.8%	52.8%	52.6%	54.8%	49.6%	50.3%	51.4%
Female	43.2%	50.2%	47.2%	47.4%	45.1%	50.1%	49.7%	48.1%
Unknown	-	-	-	-	0.2%	0.3%	0.1%	0.5%
Insurance Plan Type
Comprehensive/indemnity^Citation1	1.5%	1.3%	1.4%	1.9%	74.3%	52.0%	58.2%	54.9%
EPO/PPO	61.8%	62.5%	61.3%	60.6%	-	-	-	-
POS/POS with capitation	10.3%	9.2%	9.5%	9.8%	-	-	-	-
HMO	16.8%	12.1%	13.7%	14.8%	-	-	-	-
CDHP/HDHP	5.2%	9.9%	9.9%	8.3%	-	-	-	-
Unknown/Other	4.5%	4.9%	4.1%	4.6%	25.7%	48.0%	41.8%	45.1%
Region
Northeast	16.2%	18.1%	15.9%	15.2%	-	-	-	-
Midwest	20.5%	28.8%	23.1%	21.5%	-	-	-	-
South	44.9%	35.6%	42.6%	43.2%	-	-	-	-
West	15.0%	15.4%	16.1%	16.7%	-	-	-	-
Unknown	3.3%	2.1%	2.3%	3.3%	-	-	-	-
Race
White	-	-	-	-	49.4%	44.1%	28.2%	25.9%
Black	-	-	-	-	25.6%	26.9%	30.9%	30.1%
Hispanic	-	-	-	-	10.5%	8.4%	5.5%	6.7%
Other/Unknown	-	-	-	-	14.5%	20.5%	35.3%	37.3%

PAL: palivizumab; EPO: Exclusive Provider Organization; PPO: Preferred Provider Organization; POS: Point of Service; HMO: Health Management Organization; CDHP: Consumer Driven Health Plan; HDHP: High Deductible Health Plan.

1. Includes POS plans with or without capitation for Medicaid Insured.

Table 3. Birth characteristics of very preterm infants by palivizumab use and payer.

	Commercial			Medicaid
	PAL N = 7,772	No PAL N = 6,913	p-value	PAL N = 15,978	No PAL N = 11,051	p-value
Length of Birth Hospitalization in Days (Mean,SD)	80.7 (32.0)	69.2 (41.5)	<.001	80.5 (34.1)	67.3 (43.6)	<.001
NICU Admission (%)	99.5%	93.5%	<.001	99.6%	95.5%	<.001
Mechanical Ventilation (%)	39.8%	36.8%	<.001	40.0%	36.3%	<.001
Chronic Lung Disease of Prematurity (%)	8.4%	4.9%	<.001	6.7%	3.2%	<.001
Bronchopulmonary Dysplasia (%)	10.0%	8.7%	.011	10.9%	10.0%	.019

PAL: Palivizumab; NICU: Neonatal Intensive Care Unit.

Figure 1. Outpatient palivizumab use and rate of RSV-related hospitalizations (per 100 infant seasons) by RSV season: 2003–2020.

Table 4. RSV hospitalization characteristics of very preterm infants by palivizumab use and payer.

	Commercial			Medicaid
	PAL N = 183	No PAL N = 96	p-value	PAL N = 707	No PAL N = 447	p-value
Length of Stay (Mean, SD)	7.4 (6.6)	9.0 (12.9)	<.001	8.1 (10.8)	10.8 (14.1)	.019
Cost of Hospitalization (Mean, SD)	$40,835 (74,654)	$89,419 ($337,313)	.063	$36,138 (177,839)	$47,917 (145,836)	.241
Median	$18,666	$15,410	-	$9,079	$11,387	-
ICU Admission (%)	33.9%	36.5%	.667	35.6%	44.7%	.002
Length of Stay (Mean, SD)	9.5(7.2)	13.7(19.2)	.008	12.8 (15.6)	14.7 (14.3)	.191
Mechanical Ventilation (%)	1.6%	4.2%	.200	2.8%	6%	.007
Death (%)	0%	0%	NA	0.1%	1.3%	.011

T: Term; ICU: Intensive Care Unit; PAL: Palivizumab.

Table 5. Birth characteristics of term and very preterm infants by payer.

	Commercial			Medicaid
	Term N = 1,925,658	Very Preterm N = 13,094	p-value	Term N = 2,496,284	Very Preterm N = 27,029	p-value
Length of Birth Hospitalization in Days (Mean,SD)	3.0 (2.4)	76.0 (36.7)	<.001	3.1 (2.2)	75.1 (38.8)	<.001
NICU Admission (%)	1.3%	97.1%	<.001	1.3%	97.9%	<.001
Mechanical Ventilation (%)	0.2%	38.6%	<.001	0.2%	38.5%	<.001
Chronic Lung Disease of Prematurity (%)	0%	7.0%	<.001	0%	5.2%	<.001
Bronchopulmonary Dysplasia (%)	0%	9.5%	<.001	0%	10.6%	<.001

T: Term; PAL: Palivizumab; NICU: Neonatal Intensive Care Unit.

Figure 2. Relative risk of RSV hospitalization in term vs. very preterm infants.

Table 6. RSV hospitalization characteristics of term and very preterm infants by payer.

	Commercial			Medicaid
	Term N = 15,964	Very Preterm N = 279	p-value	Term N = 34,167	Very Preterm N = 1,154	p-value
Length of Stay (Mean, SD)	4.1 (3.2)	7.9 (9.3)	<.001	4.4 (3.7)	9.1 (12.3)	<.001
Cost of Hospitalization (Mean, SD)	$14,037 (30,592)	$57,222 ($205,654)	<.001	$9,621 (35,264)	$40,382 (167,029)	<.001
Median	$8,263	$17,578	-	$4,927	$9,801	-
ICU Admission (%)	11.8%	34.8%	<.001	13.6%	39.2%%	<.001
Length of Stay (Mean, SD)	6.1 (4.9)	11.0 (13.0)	<.001	7.9 (6.8)	13.7 (15.0)	<.001
Mechanical Ventilation (%)	0.2%	2.5%	.007	0.5%	4.1%	<.001
Death (%)	0.03%	0%	.011	0.04%	0.6%	<.001

T: Term; ICU: Intensive Care Unit.

Figueras-Aloy J, Manzoni P, Paes B, Simões EAF, Bont L, Checchia PA, Fauroux B, Carbonell-Estrany X. Defining the risk and associated morbidity and mortality of severe respiratory syncytial virus infection among preterm infants without chronic lung disease or congenital heart disease. Infect Dis Ther. 2016;5(4):1–9. doi:10.1007/s40121-016-0130-1.

 PubMedGoogle Scholar

Data availability statement

The data that support the findings of this study are available from Merative. Restrictions apply to the availability of these data, which were used under license for this study.