Total healthcare costs in the US for preterm infants with respiratory syncytial virus lower respiratory infection in the first year of life requiring medical attention

Abstract

Background:

Respiratory syncytial virus (RSV) lower respiratory infection (LRI) is the most common cause of hospitalization among infants <1 year of age. The healthcare costs of preterm infants with RSV LRI were compared with those without RSV LRI in the first year of life.

Methods:

This retrospective cohort study propensity-matched premature infants ≤36 weeks’ gestational age (wGA) and/or ≤2499 g birth weight, born May 1, 2001 through April 30, 2006 (five RSV seasons) with RSV LRI to those without RSV LRI in a national United States health plan. The primary outcome was first-year healthcare costs and utilization excluding the birth hospitalization compared between the study cohorts. Subgroup analysis evaluated costs and healthcare resource utilization by GA (≤32 wGA and 33–36 wGA) and hospitalization status (hospitalized and outpatient).

Results:

A total of 2995 infants with RSV LRI were matched to 2995 controls. Infants with RSV LRI had $9115 higher healthcare costs (RSV LRI group: $19 559; control group: $10 444; p < 0.001) in the first year of life. Late preterm infants (33–36 wGA) with an RSV hospitalization incurred $21 977 higher costs (p < 0.001) and those with an outpatient RSV LRI incurred $3898 higher costs (p < 0.001) compared to corresponding controls. Similar results were found among infants ≤32 wGA with higher costs in the RSV LRI group. Rates of all-cause hospitalizations, emergency department visits, and ambulatory visits were significantly higher among infants with RSV LRI compared to controls.

Conclusion:

Development of RSV LRI among preterm and late preterm infants is associated with significantly higher healthcare costs in the first year of life. These findings must be considered in the context of potential study limitations that may have over- or underestimated costs, such as unconfirmed RSV infection, unintentional omission of fatal cases, and unobserved imbalances between groups.

Key words: :

• Healthcare costs
• Lower respiratory infection
• Preterm infants
• Respiratory syncytial virus

Transparency

Declaration of funding

Funding for this study was provided by MedImmune, the manufacturer of palivizumab.

Declaration of financial/other relationships

D.S. and J.R. have disclosed that they provided consultant services to MedImmune. D.S. has also disclosed that he has provided consultant services to Hospira and is on the speakers’ bureaus of Ikaria, Abbott Nutrition and Ovation. In addition, J.R. has disclosed that he has received funding from MedImmune and has served on MedImmune's Speakers’ Bureau. E.B. has disclosed that she is employed by i3 Innovus, which was contracted by MedImmune to do the analysis. A.F. and P.M. have disclosed that they are employees of MedImmune.

Some peer reviewers receive honoraria from CMRO for their review work. Peer reviewer 1 has disclosed that he/she is associated with EMax Consulting. The other peer reviewer has disclosed that he/she has no relevant financial relationships.

Acknowledgment

The authors thank Laura Kay Becker and Lynn Wacha of i3 Innovus for their analytic and programming support for this study. The authors also acknowledge Physicians World, funded by MedImmune, for providing editing support.