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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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


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.


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.


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.

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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