5505

Increased Medical Costs and Use within a Year After Respiratory Syncytial Virus Lower Respiratory Tract Infection Among Commercially-Insured Late-Preterm Infants

Friday, October 16, 2009
145 (Washington Convention Center)
Liisa Palmer, PhD1, Caroline B. Hall, MD2, Julie Katkin, MD3, Nianwen Shi, PhD4, Anthony S. Masaquel, PhD, MPH5, Kimmie K. McLaurin, MS5 and Parthiv J. Mahadevia, MD, MPH5, (1)Healthcare, Thomson Reuters, Washington, DC, (2)Pediatrics, University of Rochester Medical School, Rochester, NY, (3)Pediatrics-Pulmonary, Baylor College of Medicine, Houston, TX, (4)Healthcare, Thomson Reuters, Cambridge, MA, (5)Health Outcomes and Pharmacoeconomics, MedImmune, Gaithersburg, MD

Purpose: To compare the total healthcare costs and use within a year among late-preterm infants with respiratory syncytial virus (RSV) lower respiratory tract infection (LRI) and a similar cohort of control infants without RSV LRI in a non-capitated, commercially insured population.

Methods: Late-preterm infants (33–36 wk gestational age and <1 year of age) were identified in the MarketScan® research databases from January 2003 to March 2007. We examined all claims with a code for RSV and classified infants as inpatient or outpatient. RSV LRI was defined as occurring within 14 days of the date of the first claim. The control cohort consisted of infants without an RSV code and was comparable to the diseased cohorts with regard to patient and clinical characteristics using propensity score weighting. Total medical costs up to a year after RSV LRI were evaluated using a logged ordinary least squares model. Respiratory-related diagnoses and procedures were evaluated descriptively between RSV and control cohorts.

Results: Total costs within a year were significantly higher for both RSV inpatient ($29,516) and RSV outpatient ($8192) cohorts compared with controls ($5489; P<0.0001). Costs excluding the index episode were higher for the RSV inpatient ($8687; P=0.004) and RSV outpatient ($7065; P=0.055) cohorts compared with controls ($5155). Rates of wheezing and asthma within a year were significantly higher in the RSV cohorts compared with controls (P<0.001).  

Respiratory Diagnoses and Procedures Within a Year After RSV LRI

RSV Inpatient

(n=88)

RSV Outpatient

(n=262)

Control

(n=1870)

Respiratory Diagnoses, %

  Wheezing

20.7

16.3

4.1

  Asthma

27.5

22.9

3.8

Procedures, %

  Oxygen Use

18.3

4.6

1.6

  Chest radiograph

89.6

42.5

13.0

  Pulse oximetry

23.0

26.0

5.3

Medication, %

  Bronchodilators

74.6

60.8

10.3

  Steroids

52.6

43.1

11.8

  Antibiotics

88.2

86.0

62.8

Visits, mean (SD)

  Inpatient

1.3 (0.8)

1.2 (0.9)

0.1 (0.4)

  Emergency

1.7 (2.8)

2.1 (2.7)

0.5 (1.4)

  Outpatient

12.0 (8.4)

9.6 (6.9)

6.9 (6.1)

For all comparisons of RSV inpatient or RSV outpatient cohort compared with control, P<0.001

Conclusions: RSV LRI among late-preterm infants in a commercially insured population is associated with increased rates of respiratory illness and costs of both inpatient and outpatient services at least a year beyond the initial RSV LRI.

This study was sponsored by MedImmune.