Effect of the Revised AAP Statement for Palivizumab Eligibility on Enrolment and Drug Cost in a Retrospective Provincial Cohort of Premature Infants
CPS ePoster Library. Chiu A. Jun 25, 2015; 99184; 122
A. Chiu
A. Chiu
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Abstract
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Background

Recommendations for palivizumab immunoprophylaxis in premature infants have changed in response to general improvements in outcomes of premature infants and changes in demographic and frequency of RSV-related hospitalization. In August 2014, AAP revised its policy statement limiting palivizumab prophylaxis in premature infants to those < 29 weeks gestation. The effect of this change is uncertain but can be estimated on previous cohorts.
Objective: To assess the impact of the revised eligibility criteria for palivizumab prophylaxis on the number of eligible premature infants and the cost of palivizumab used

Method:

The Manitoba RSV Immunoprophylaxis Program coordinates RSV immunoprophylaxis for the province of Manitoba. The Program receives notification of all births < 35 weeks gestation. Premature infants ≤ 32 weeks gestation, and 33-35 weeks gestation at high risk for RSV-related hospitalization (based on risk scoring or residing in remote communities) are eligible for immunoprophylaxis. Anonymized data from the three seasons (2011-14) on the number of premature infants enrolled, amount of palivizumab received, and proportional cost of palivizumab was abstracted and reanalyzed applying < 29 weeks gestation as cut-off for eligibility.

Results:

For the three seasons, 672 premature infants [table 1] were enrolled and received palivizumab. Total cost of palivizumab for this cohort was $2,877,096 (Canadian). Limiting eligibility to < 29 weeks gestation reduced enrollment to 113 premature infants with cost of palivizumab of $467,684. Revision to eligibility criteria would have resulted in 559 fewer infants receiving palivizumab and a cost reduction of $2,409,412 over the past 3 seasons.

Conclusions:

The AAP revised policy statement limiting palivizumab eligibility to premature infants < 29 weeks gestation will have a large impact reducing number of premature infants eligible and the cost of palivizumab utilized. In a provincial-based cohort, retrospective application of the new eligibility criteria would have resulted in 559 fewer eligible infants and a cost reduction of $2.4 million over the past 3 seasons.

Table:
Current Program Enrolment Using Revised AAP Statement
≤32 33-35 Total Premature Infants Cost palivizumab <29 Cost palivizumab Not Enrolled Palivizumab expenditure decrease
2011-12 161 83 244 945,740 31 135,979 213 809,761
2012-13 155 82 237 1,071,825 35 138,458 202 933,367
2013-14 154 37 191 859,531 47 193,247 144 666,284
2011-14 470 202 672 2,877,096 113 467,684 559 2,409,412
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