The Economic Implications of RSV bronchiolitis in the Mid-West F McElligott A Mirza, S Kinsella, RK Philip

Background Commonest resp tract infection in infancy Majority of admissions are for supportive measures + observation Prophylaxis options are RSV IVIG or palivizumab Costly method of reducing admissions to paediatric wards

Commonest resp tract infection in infancy

Majority of admissions are for supportive measures + observation

Prophylaxis options are RSV IVIG or palivizumab

Costly method of reducing admissions to paediatric wards

Method Retrospective HIPE-data analysis from october 1999- jan 2007 Data cleaned and analysed using SPSS ® version 14.0 and included Born in Mid-Western Regional Maternity Hosp RSV + Age <1 year at start of relevant bronchiolitis season Cost calculated at bed occupancy rates

Retrospective HIPE-data analysis from october 1999- jan 2007

Data cleaned and analysed using SPSS ® version 14.0 and included

Born in Mid-Western Regional Maternity Hosp

RSV +

Age <1 year at start of relevant bronchiolitis season

Cost calculated at bed occupancy rates

Results of the cohort Table 1: Admissions , length of stay and cost per gestational age group € 147,232.64 € 31,000.00 € 76,969.28 Cost of inpatient admissions 148.42 31.25 77.59 Total number of bed-days used 543 28 7 Number of admissions 32 +1 -35 28-32 <28

Overall admission trends

Total Cost of RSV admissions € 2,469,901.44 2489.62 bed days (6.8 bed years)

€ 2,469,901.44

2489.62 bed days (6.8 bed years)

Distribution of cost Figure 1: scatterplot showing seasonal distribution of admissions and variation in length of stay

Cost of Paluvizumab Table 2: Cost of prophylaxis per gestational age group € 1,318,188.08 € 180,662.75 € 85,768.93 Average cost per year € 10,545,504.60 € 1,444,982.00 € 686,151.44 Cost per gestational group over 8 years studied € 7,852.20 € 7,224.91 € 6,597.61 Cost estimated to give paluvizumab for one season (5 doses) 1,343 200 104 Birth rate 32 +1 - 35 28-32 <28

Cost effectivness (No. of babies in group not admitted * cost for an average stay for that group) less (cost of prophylaxis * no. of babies) less (cost of babies admitted) Ie for the <28/40 group: Cost = (97*992.00*3.5) – (686,151.44) – 76,969.28 = - 426,326.72

(No. of babies in group not admitted * cost for an average stay for that group)

less

(cost of prophylaxis * no. of babies)

less

(cost of babies admitted)

Ie for the <28/40 group:

Cost = (97*992.00*3.5) – (686,151.44) – 76,969.28

= - 426,326.72

Conclusions RSV admissions are increasing Prophylaxis is having a positive effect on on admissions in premature babies but at high financial cost Widening our criteria for Palivizumab will have enormous financial implications

RSV admissions are increasing

Prophylaxis is having a positive effect on on admissions in premature babies but at high financial cost

Widening our criteria for Palivizumab will have enormous financial implications