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Okubo Y, Uda K, Ogimi C, Shimabukuro R, Ito K. Clinical Practice Patterns and Risk Factors for Severe Conditions in Pediatric Hospitalizations With Respiratory Syncytial Virus in Japan: A Nationwide Analyses (2018-2022). Pediatr Infect Dis J 2024; 43:187-193. [PMID: 37991478 DOI: 10.1097/inf.0000000000004181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) represents a global health challenge, especially among younger children. While the disease burden in Japan has been preliminarily quantified, there remains a lack of comprehensive understanding regarding treatment patterns and the influence of known risk factors at a national scale. MATERIALS AND METHODS We conducted a retrospective cohort study consisting of 50,482 children under 5 years hospitalized with RSV infections during 2018-2022 using the Medical Data Vision database. We investigated trends in patient characteristics, health resource use, treatment patterns, and laboratory data. Additionally, multivariable modified Poisson regression models were used to investigate the risk factors associated with severe conditions. RESULTS We observed an increasing trend in the inpatient healthcare costs and decreasing trends in the use of antibiotics, bronchodilators, systemic corticosteroids and other symptomatic medications from 2018 to 2022. Risk factors associated with severe RSV infections were children less than 1 year (risk ratio, 2.90; 95% CI: 2.53-3.32) and the number of complex chronic diseases (risk ratio for 1 disease, 2.68; 95% CI: 2.34-3.06: risk ratio for 2 or more diseases, 6.91; 95% CI: 5.81-8.21). Annual inpatient healthcare costs for RSV infections were estimated at 11-14 billion Japanese Yen for younger children. CONCLUSIONS Our study observed the changes in practice patterns and health resource use for children hospitalized with RSV infections and identified risk factors associated with severe conditions. These findings provide insights for policymakers and clinicians aiming to devise strategies for further improving clinical practices, including newly developed vaccines and single-dose long-acting monoclonal antibodies.
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Affiliation(s)
- Yusuke Okubo
- From the Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kazuhiro Uda
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Chikara Ogimi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Rinshu Shimabukuro
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kenta Ito
- Department of General Pediatrics, Aichi Children's Health and Medicine Hospital, Obu, Japan
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Keary IP, Ravasio R, Fullarton JR, Manzoni P, Lanari M, Paes BA, Carbonell-Estrany X, Baraldi E, Tarride JÉ, Rodgers-Gray B. A new cost-utility analysis assessing risk factor-guided prophylaxis with palivizumab for the prevention of severe respiratory syncytial virus infection in Italian infants born at 29-35 weeks' gestational age. PLoS One 2023; 18:e0289828. [PMID: 37561741 PMCID: PMC10414677 DOI: 10.1371/journal.pone.0289828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
Since the last Italian cost-utility assessment of palivizumab in 2009, new data on the burden of respiratory syncytial virus (RSV) and an International Risk Scoring Tool (IRST) have become available. The objective of this study was to provide an up-to-date cost-utility assessment of palivizumab versus no prophylaxis for the prevention of severe RSV infection in otherwise healthy Italian infants born at 29-31 weeks' gestational age (wGA) infants and those 32-35wGA infants categorized as either moderate- or high-risk of RSV-hospitalization (RSVH) by the IRST. A decision tree was constructed in which infants received palivizumab or no prophylaxis and then could experience: i) RSVH; ii) emergency room medically-attended RSV-infection (MARI); or, iii) remain uninfected/non-medically attended. RSVH cases that required intensive care unit admission could die (0.43%). Respiratory morbidity was considered in all surviving infants up to 18 years of age. Hospitalization rates were derived from Italian data combined with efficacy from the IMpact-RSV trial. Palivizumab costs were calculated from vial prices (50mg: €490.37 100mg: €814.34) and Italian birth statistics combined with a growth algorithm. A lifetime horizon and healthcare and societal costs were included. The incremental cost-utility ratio (ICUR) was €14814 per quality-adjusted life year (QALY) gained in the whole population (mean: €15430; probability of ICUR being <€40000: 0.90). The equivalent ICURs were €15139 per QALY gained (€15915; 0.89) for 29-31wGA infants and €14719 per QALY gained (€15230; 0.89) for 32-35wGA infants. The model was most sensitive to rates of long-term sequelae, utility scores, palivizumab cost, and palivizumab efficacy. Palivizumab remained cost-effective in all scenario analyses, including a scenario wherein RSVH infants received palivizumab without a reduction in long-term sequelae and experienced a 6-year duration of respiratory morbidity (ICUR: €27948 per QALY gained). In conclusion, palivizumab remains cost-effective versus no prophylaxis in otherwise healthy Italian preterm infants born 29-35wGA. The IRST can help guide cost-effective use of palivizumab in 32-35wGA infants.
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Affiliation(s)
- Ian P. Keary
- Violicom Medical Limited, Aldermaston, Berkshire, United Kingdom
| | | | | | - Paolo Manzoni
- Department of Public Health and Pediatric Sciences, University of Torino School of Medicine, Turin, Piedmont, Italy
- Division of Paediatrics and Neonatology, Degli Infermi Hospital, Ponderano, Italy
| | - Marcello Lanari
- Paediatric Emergency Unit, IRCCS-Policlinico Ospedaliero-Universitario di Bologna, Bologna, Italy
| | - Bosco A. Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | | | - Eugenio Baraldi
- Department of Women’s and Children’s Health, University Hospital of Padova, Veneto, Italy
- Institute of Pediatric Research, "Città della Speranza", Padova, Veneto, Italy
| | - Jean-Éric Tarride
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
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Rodgers-Gray BS, Fullarton JR, Carbonell-Estrany X, Keary IP, Tarride JÉ, Paes BA. Impact of using the International Risk Scoring Tool on the cost-utility of palivizumab for preventing severe respiratory syncytial virus infection in Canadian moderate-to-late preterm infants. J Med Econ 2023; 26:630-643. [PMID: 37067826 DOI: 10.1080/13696998.2023.2202600] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND AND OBJECTIVE To assess the cost-utility of palivizumab versus no prophylaxis in preventing severe respiratory syncytial virus (RSV) infection in Canadian moderate-to-late preterm (32-35 weeks' gestational age) infants using an: i) International Risk Scoring Tool (IRST); ii) Canadian RST (CRST). METHODS A decision tree was developed to assess cost-utility. Infants assessed at moderate- and high-risk of RSV-related hospitalization (RSVH) by the IRST or CRST received palivizumab or no prophylaxis and then progressed to either: i) RSVH; ii) emergency room/outpatient medically attended RSV-infection (MARI); or, iii) were uninfected/non-medically attended. Infants admitted to intensive care could incur mortality (0.43%). Respiratory morbidity was accounted in all uninfected surviving infants for 6 years or 18 years (RSVH/MARI). Palivizumab efficacy (72.2% RSVH reduction) and hospital outcomes were from the Canadian CARESS, PICNIC and RSV-Quebec studies. Palivizumab costs (50mg: CAN$752; 100mg: $1,505) were calculated from Canadian birth statistics combined with a growth algorithm. Healthcare/payer and societal costs (May 2022; 1.5% discounting) were included. RESULTS Cost per quality-adjusted life year (QALY) was $29,789 with the IRST (0.79 probability of being <$50,000) and $15,833 with the CRST (0.96 probability). The model was most sensitive to utility scores, long-term sequelae, and palivizumab cost. Vial sharing improved the incremental cost-utility ratio (IRST: $22,319; CRST: $9,231). CONCLUSIONS Palivizumab was highly cost-effective (vs no prophylaxis) in Canadian moderate-to-late preterm infants using either the IRST or CRST. The IRST has fewer risk factors than the CRST (3 vs 7, respectively), captures more potential RSVHs (85% vs 54%) and provides another option to guide cost-effective RSV prophylaxis in Canada.
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Affiliation(s)
| | | | | | - Ian P Keary
- Violicom Medical Limited, Aldermaston, United Kingdom
| | - Jean-Éric Tarride
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada
| | - Bosco A Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Canada
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Manzoni P, Baraldi E, Luna MS, Tzialla C. Real-World Studies of Respiratory Syncytial Virus Hospitalizations among Moderate/Late Preterm Infants Exposed to Passive Immunoprophylaxis with Palivizumab. Am J Perinatol 2022; 39:S7-S13. [PMID: 36307092 DOI: 10.1055/s-0042-1757279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This article aims to assess the real-world effectiveness of palivizumab immunoprophylaxis against respiratory syncytial virus (RSV)-associated hospitalization (RSVH) rates in otherwise healthy moderate/late preterm infants and discuss the role of palivizumab in preventing acute and long-term outcomes. We identified studies in the PubMed and Embase databases that reported patient-level data on (1) exposure to palivizumab in preterm infants born between 29 and 35 weeks of gestational age (or subsets within this range) ≤ 2 years of chronological age, and (2) the outcome of RSVH. Six studies assessed RSVH in infants this gestational age who had been exposed or not to palivizumab and reported patient-level data. Exposure was associated with a reduction in RSVH rates that was comparable to the reduction seen in controlled clinical trials (weighed mean 4.0-fold reduction). RSV immunoprophylaxis in preterm infants within 29 to 35 weeks of gestational age is associated with a considerably lower burden of RSVH. KEY POINTS: · RSV is the leading cause of lower respiratory tract infection hospitalization in infants.. · Palivizumab prevents RSVH in a real-world scenario.. · Immunoprophylaxis should be used in high-risk infants..
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Affiliation(s)
- Paolo Manzoni
- Department of Maternal Infant Medicine, Degli Infermi Hospital, Biella, Italy.,University of Torino, Turin, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Manuel Sánchez Luna
- Neonatology Division and NICU, University Hospital Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, Italy
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Prendergast C, Robinson J, Caya C, Perez Trejo ME, Guan I, Hébert-Murakami V, Marianayagam J, Wong ZW, Walker C, Goldfarb DM, Barrowman N, Jetty R, Embree J, Papenburg J. Urgent air transfers for acute respiratory infections among children from Northern Canada, 2005–2014. PLoS One 2022; 17:e0272154. [PMID: 35901042 PMCID: PMC9333212 DOI: 10.1371/journal.pone.0272154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 07/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background The incidence of hospitalizations for acute respiratory infections (ARI) among young Indigenous children from Northern Canada is consistently high. ARIs requiring urgent air transfer can be life-threatening and costly. We aimed to describe their epidemiology, estimate age-specific incidences, and explore factors associated with level of care required. Methods We undertook a retrospective cohort study of children <5 years old from Northern Canada transferred by urgent air transport for ARI from 2005 through 2014 to 5 pediatric tertiary care centers in Vancouver, Edmonton, Winnipeg, Ottawa and Montreal. Admissions were identified via ARI-related ICD-9/10 coding and forward sortation area. Descriptive statistics and univariable analyses were performed. Results Among 650 urgent air transfers, the majority were from Nunavut (n = 349, 53.7%) or Nunavik (n = 166, 25.5%), <6 months old (n = 372, 57.2%), and without underlying comorbidity (n = 458; 70.5%). Estimated annual tertiary care ARI admission rates in infants <1 year old from Nunavut (40.7/1000) and Nunavik (44.5/1000) were tenfold higher than in children aged 1 to 4 years. Bronchiolitis (n = 333, 51.2%) and pneumonia (n = 208, 32.0%) were the most common primary discharge diagnoses. Nearly half required critical care (n = 316, 48.6%); mechanical ventilation rates ranged from 7.2% to 55.9% across centres. The most common primary pathogen was respiratory syncytial virus (n = 196, 30.1%). Influenza A or B was identified in 35 cases (5.4%) and vaccine-preventable bacterial infections in 27 (4.1%) cases. Interpretation Urgent air transfers for ARI from Northern Canada are associated with high acuity. Variations in levels of care were seen across referral centers, age groups and pathogens.
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Affiliation(s)
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Chelsea Caya
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Maria E. Perez Trejo
- Research Institute of the Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Iline Guan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, Montreal, Canada
| | - Veronica Hébert-Murakami
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, Montreal, Canada
| | - Justina Marianayagam
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
- Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Zing-Wae Wong
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Celia Walker
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - David M. Goldfarb
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Nick Barrowman
- Research Institute of the Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Radha Jetty
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Joanne Embree
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, Montreal, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, Optilab Montreal, McGill University Health Centre, Montreal, Canada
- * E-mail:
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Rafferty E, Paulden M, Buchan SA, Robinson JL, Bettinger JA, Kumar M, Svenson LW, MacDonald SE. Evaluating the Individual Healthcare Costs and Burden of Disease Associated with RSV Across Age Groups. PHARMACOECONOMICS 2022; 40:633-645. [PMID: 35553028 PMCID: PMC9130187 DOI: 10.1007/s40273-022-01142-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of acute respiratory infection (ARI), with high morbidity and mortality worldwide. RSV costing and burden estimates can highlight the potential benefits of future vaccination programs and are essential for economic evaluations. OBJECTIVE We aimed to determine RSV healthcare costs across age groups and the overall disease burden of medically attended RSV in Canada. METHODS We conducted a retrospective case-control study to estimate the attributable healthcare costs per RSV case in Alberta. We used two case definitions to capture diversity in case severity: laboratory-confirmed RSV and ARI attributable to RSV. Matching occurred on five criteria: (1) age, (2) urban/rural status, (3) sex, (4) prematurity and (5) Charlson Comorbidity Index score. We calculated the age-specific burden of medically attended RSV in Canada from 2010 to 2019 by multiplying the weekly age-specific incidence of medically attended ARI with the RSV positivity rate. RESULTS Costs per laboratory-confirmed RSV case were (in Canadian dollars [CAD], year 2020 values) $CAD12,713 and 40,028 in the first 30 and 365 days following diagnosis, respectively, whereas a case of ARI potentially attributable to RSV cost $CAD316 and 915, in 30 and 365 days, respectively. Older (aged ≥ 65 years) and younger (aged < 90 days) age groups had the highest case costs. The average medically attended RSV incidence rate across nine seasons was 1743 cases per 100,000 people per year. CONCLUSIONS RSV is a common and expensive infection at the extremes of life, and the development of immunization programs targeting older and younger ages may be important for the reduction of RSV burden and cost.
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Affiliation(s)
- Ellen Rafferty
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
- Institute of Health Economics, #1200, 10405 Jasper Avenue, Edmonton, AB, T5J 3N4, Canada.
| | - Mike Paulden
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sarah A Buchan
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Manoj Kumar
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Lawrence W Svenson
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Analytics and Performance Reporting, Alberta Health, Edmonton, AB, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Vigneault LP, Diendere E, Sohier-Poirier C, Abi Hanna M, Poirier A, St-Onge M. Acute health care among Indigenous patients in Canada: a scoping review. Int J Circumpolar Health 2021; 80:1946324. [PMID: 34320910 PMCID: PMC8330756 DOI: 10.1080/22423982.2021.1946324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022] Open
Abstract
A recent report by the Chief Public Health Officer of Canada demonstrates the inferior health status of Indigenous Peoples in Canada when compared to non-Indigenous populations. This scoping review maps out the available literature concerning acute health care for Indigenous Peoples in Canada in order to better understand the health care issues they face. All existing articles concerning health care provided to Indigenous Peoples in Canada in acute settings were included in this review. The targeted studied outcomes were access to care, health care satisfaction, hospital visit rates, mortality, quality of care, length of stay and cost per hospitalisation. 114 articles were identified. The most studied outcomes were hospitalisation rates (58.8%), length of stay (28.0%), mortality (25.4%) and quality of care (24.6%) Frequently studied topics included pulmonary disease, injuries, cardiovascular disease and mental illness. Indigenous Peoples presented lower levels of satisfaction and access to care although they tend to be over-represented in hospitalisation rates for acute care. Greater inclusion of Indigenous Peoples in the health care system and in the training of health care providers is necessary to ensure a better quality of care that is culturally safe for Indigenous Peoples.
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Affiliation(s)
| | - Ella Diendere
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL), Quebec, Canada
| | | | - Margo Abi Hanna
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Annie Poirier
- Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada
| | - Maude St-Onge
- Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada
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Nourbakhsh S, Shoukat A, Zhang K, Poliquin G, Halperin D, Sheffield H, Halperin SA, Langley JM, Moghadas SM. Effectiveness and cost-effectiveness of RSV infant and maternal immunization programs: A case study of Nunavik, Canada. EClinicalMedicine 2021; 41:101141. [PMID: 34622186 PMCID: PMC8479643 DOI: 10.1016/j.eclinm.2021.101141] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite passive immunization with palivizumab to select high-risk children under two years of age, the health and economic burden of respiratory syncytial virus (RSV) remains substantial. We evaluated the effectiveness and cost-effectiveness of immunization programs with new generations of RSV prophylactics, including long-acting monoclonal antibodies (LAMA) and maternal vaccines, in terms of reducing hospitalizations in Nunavik, a Canadian Arctic region. METHODS We developed an agent-based model of RSV transmission and parameterized it with the demographics and burden of RSV in Nunavik, Québec. We compared various immunization strategies, taking into account the costs associated with program delivery and calculating the incremental cost-effectiveness ratio (ICER) using quality-adjusted life-years (QALYs) gained as a measure of effectiveness. Scenario analyses included immunization with palivizumab and LAMA for infants under one year of age, and maternal vaccination in mild, moderate, and severe RSV seasons. Data were analysed from November 1, 2019 to May 1, 2021. FINDINGS We found that a Nunavik pilot program with palivizumab which included healthy full-term infants aged 0-2 months in addition to those considered high-risk for complicated RSV disease is not cost-effective, compared to offering palivizumab only to preterm/chronically ill infants under 1 year of age. Using LAMA as prophylaxis produces ICER values of CAD $39,414/QALY (95% Credible Interval [CrI]: $39,314-$40,017) in a mild season (moderately cost-effective) and CAD $5,255/QALY (95% CrI: $5,222-$5,307) in a moderate season (highly cost-effective). LAMA was a dominant (cost-saving with negative incremental costs and positive incremental effects) strategy in a severe RSV season. Maternal vaccination combined with immunization of preterm/chronically ill infants 3-11 months was also a dominant (cost-saving) strategy in all seasons. INTERPRETATION The switch from palivizumab in RSV immunization programs to new prophylactics would lead to significant savings, with LAMA being an effective strategy without compromising benefits in terms of reducing hospitalizations.
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Affiliation(s)
- Shokoofeh Nourbakhsh
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario M3J 1P3, Canada
| | - Affan Shoukat
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario M3J 1P3, Canada
| | - Kevin Zhang
- Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Guillaume Poliquin
- Department of Medical Microbiology and Infectious Diseases, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba R3E 0J9, Canada
- Office of the Scientific Director, National Microbiology Laboratories, Public Health Agency of Canada, Winnipeg, Manitoba R3E 3R2, Canada
| | - Donna Halperin
- School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia B2G 2W5, Canada
| | - Holden Sheffield
- Department of Paediatrics, Qikiqtani General Hospital, Iqaluit, Nunavut X0A 0H0, Canada
| | - Scott A. Halperin
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia B3K 6R8, Canada
| | - Joanne M. Langley
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia B3K 6R8, Canada
| | - Seyed M. Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario M3J 1P3, Canada
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9
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Thampi N, Knight BD, Thavorn K, Webster RJ, Lanctot K, Hawken S, McNally JD. Health care costs of hospitalization of young children for respiratory syncytial virus infections: a population-based matched cohort study. CMAJ Open 2021; 9:E948-E956. [PMID: 34667075 PMCID: PMC8526091 DOI: 10.9778/cmajo.20200219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection poses a substantial clinical burden among infants and young children. We sought to determine the health care costs of hospitalizations attributable to RSV in Ontario, Canada, from the health care payer perspective. METHODS For this population-based matched cohort study, we identified children younger than 24 months who were or were not hospitalized with RSV infections in 2006-2016. We performed a cost-of-illness analysis using linked administrative health data, with subjects stratified by gestational age and congenital heart disease, and propensity score-matched on established risk factors. The primary outcome was attributable health care costs per patient, reflecting the difference in direct medical costs between the groups, calculated to 12 months postdischarge in 2020 Canadian dollars. RESULTS We identified 14 608 RSV-infected children, matched to 72 040 controls. The adjusted attributable cost of hospitalized RSV was $134 931 900 over 10 years, or $9240 per patient (95% confidence interval [CI] $8790-$9690). Health care costs escalated 3 days before hospitalization, and persisted up to 12 months after discharge. Increased costs were associated with major comorbidities, but not extreme premature birth. The highest mean attributable cost per patient was in the presence of hemodynamically significant heart disease ($60 110, 95% CI $26 700-$93 060). Infants born at 36-43 weeks' gestation constituted the greatest overall cost burden at $117 886 720. INTERPRETATION Although the greatest direct medical costs per patient hospitalized with RSV infection are among children with cardiac disease, the greatest overall cost burden is from children born at or near term, who are not targeted by current prophylaxis strategies. The substantial attributable health care costs of RSV can inform cost-effectiveness analyses of novel RSV vaccines and prioritization of health care resources.
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Affiliation(s)
- Nisha Thampi
- Department of Pediatrics (Thampi, McNally), Faculty of Medicine, University of Ottawa; CHEO Research Institute (Thampi, McNally); ICES uOttawa (Knight); Ottawa Hospital Research Institute (Knight, Thavorn); Clinical Research Unit, CHEO Research Institute (Knight, Webster); Ontario Child Health Support Unit (Knight, Webster); School of Epidemiology and Public Health (Thavorn, Hawken), University of Ottawa, Ottawa, Ont.; ICES Central (Thavorn, Hawken), Toronto, Ont.; Clinical Epidemiology Program (Thavorn), Ottawa, Ont.; Sunnybrook Research Institute (Lanctot), University of Toronto, Toronto, Ont.; Clinical Epidemiology Program (Hawken), Ottawa Hospital Research Institute, Ottawa, Ont.
| | - Braden D Knight
- Department of Pediatrics (Thampi, McNally), Faculty of Medicine, University of Ottawa; CHEO Research Institute (Thampi, McNally); ICES uOttawa (Knight); Ottawa Hospital Research Institute (Knight, Thavorn); Clinical Research Unit, CHEO Research Institute (Knight, Webster); Ontario Child Health Support Unit (Knight, Webster); School of Epidemiology and Public Health (Thavorn, Hawken), University of Ottawa, Ottawa, Ont.; ICES Central (Thavorn, Hawken), Toronto, Ont.; Clinical Epidemiology Program (Thavorn), Ottawa, Ont.; Sunnybrook Research Institute (Lanctot), University of Toronto, Toronto, Ont.; Clinical Epidemiology Program (Hawken), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Kednapa Thavorn
- Department of Pediatrics (Thampi, McNally), Faculty of Medicine, University of Ottawa; CHEO Research Institute (Thampi, McNally); ICES uOttawa (Knight); Ottawa Hospital Research Institute (Knight, Thavorn); Clinical Research Unit, CHEO Research Institute (Knight, Webster); Ontario Child Health Support Unit (Knight, Webster); School of Epidemiology and Public Health (Thavorn, Hawken), University of Ottawa, Ottawa, Ont.; ICES Central (Thavorn, Hawken), Toronto, Ont.; Clinical Epidemiology Program (Thavorn), Ottawa, Ont.; Sunnybrook Research Institute (Lanctot), University of Toronto, Toronto, Ont.; Clinical Epidemiology Program (Hawken), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Richard J Webster
- Department of Pediatrics (Thampi, McNally), Faculty of Medicine, University of Ottawa; CHEO Research Institute (Thampi, McNally); ICES uOttawa (Knight); Ottawa Hospital Research Institute (Knight, Thavorn); Clinical Research Unit, CHEO Research Institute (Knight, Webster); Ontario Child Health Support Unit (Knight, Webster); School of Epidemiology and Public Health (Thavorn, Hawken), University of Ottawa, Ottawa, Ont.; ICES Central (Thavorn, Hawken), Toronto, Ont.; Clinical Epidemiology Program (Thavorn), Ottawa, Ont.; Sunnybrook Research Institute (Lanctot), University of Toronto, Toronto, Ont.; Clinical Epidemiology Program (Hawken), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Krista Lanctot
- Department of Pediatrics (Thampi, McNally), Faculty of Medicine, University of Ottawa; CHEO Research Institute (Thampi, McNally); ICES uOttawa (Knight); Ottawa Hospital Research Institute (Knight, Thavorn); Clinical Research Unit, CHEO Research Institute (Knight, Webster); Ontario Child Health Support Unit (Knight, Webster); School of Epidemiology and Public Health (Thavorn, Hawken), University of Ottawa, Ottawa, Ont.; ICES Central (Thavorn, Hawken), Toronto, Ont.; Clinical Epidemiology Program (Thavorn), Ottawa, Ont.; Sunnybrook Research Institute (Lanctot), University of Toronto, Toronto, Ont.; Clinical Epidemiology Program (Hawken), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Steven Hawken
- Department of Pediatrics (Thampi, McNally), Faculty of Medicine, University of Ottawa; CHEO Research Institute (Thampi, McNally); ICES uOttawa (Knight); Ottawa Hospital Research Institute (Knight, Thavorn); Clinical Research Unit, CHEO Research Institute (Knight, Webster); Ontario Child Health Support Unit (Knight, Webster); School of Epidemiology and Public Health (Thavorn, Hawken), University of Ottawa, Ottawa, Ont.; ICES Central (Thavorn, Hawken), Toronto, Ont.; Clinical Epidemiology Program (Thavorn), Ottawa, Ont.; Sunnybrook Research Institute (Lanctot), University of Toronto, Toronto, Ont.; Clinical Epidemiology Program (Hawken), Ottawa Hospital Research Institute, Ottawa, Ont
| | - J Dayre McNally
- Department of Pediatrics (Thampi, McNally), Faculty of Medicine, University of Ottawa; CHEO Research Institute (Thampi, McNally); ICES uOttawa (Knight); Ottawa Hospital Research Institute (Knight, Thavorn); Clinical Research Unit, CHEO Research Institute (Knight, Webster); Ontario Child Health Support Unit (Knight, Webster); School of Epidemiology and Public Health (Thavorn, Hawken), University of Ottawa, Ottawa, Ont.; ICES Central (Thavorn, Hawken), Toronto, Ont.; Clinical Epidemiology Program (Thavorn), Ottawa, Ont.; Sunnybrook Research Institute (Lanctot), University of Toronto, Toronto, Ont.; Clinical Epidemiology Program (Hawken), Ottawa Hospital Research Institute, Ottawa, Ont
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10
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Fitzpatrick T, McNally JD, Stukel TA, Lu H, Fisman D, Kwong JC, Guttmann A. Family and Child Risk Factors for Early-Life RSV Illness. Pediatrics 2021; 147:peds.2020-029090. [PMID: 33737374 DOI: 10.1542/peds.2020-029090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Most infants hospitalized with respiratory syncytial virus (RSV) do not meet common "high-risk" criteria and are otherwise healthy. The objective of this study was to quantify the risks and relative importance of socioeconomic factors for severe, early-life RSV-related illness. We hypothesized several of these factors, particularly those indicating severe social vulnerability, would have statistically significant associations with increased RSV hospitalization rates and may offer impactful targets for population-based RSV prevention strategies, such as prophylaxis programs. METHODS We used linked health, laboratory, and sociodemographic administrative data for all children born in Ontario (2012-2018) to identify all RSV-related hospitalizations occurring before the third birthday or end of follow-up (March 31, 2019). We estimated rate ratios and population attributable fractions using a fully adjusted model. RESULTS A total of 11 782 RSV-related hospitalizations were identified among 789 484 children. Multiple socioeconomic factors were independently associated with increased RSV-related admissions, including young maternal age, maternal criminal involvement, and maternal history of serious mental health and/or addiction concerns. For example, an estimated 4.1% (95% confidence interval: 2.2 to 5.9) of RSV-related admissions could be prevented by eliminating the increased admissions risks among children whose mothers used welfare-based drug insurance. Notably, 41.6% (95% confidence interval: 39.6 to 43.5) of admissions may be prevented by targeting older siblings (eg, through vaccination). CONCLUSIONS Many social factors were independently associated with early-life RSV-related hospitalization. Existing RSV prophylaxis and emerging vaccination programs should consider the importance of both clinical and social risk factors when determining eligibility and promoting compliance.
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Affiliation(s)
- Tiffany Fitzpatrick
- ICES, Toronto, Ontario, Canada.,Dalla Lana School of Public Health.,Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - J Dayre McNally
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Thérèse A Stukel
- ICES, Toronto, Ontario, Canada.,Dalla Lana School of Public Health.,Institute for Health Policy, Management and Evaluation
| | - Hong Lu
- ICES, Toronto, Ontario, Canada
| | | | - Jeffrey C Kwong
- ICES, Toronto, Ontario, Canada.,Dalla Lana School of Public Health.,Institute for Health Policy, Management and Evaluation.,Public Health Ontario, Toronto, Ontario, Canada; and.,Department of Family and Community Medicine.,Centre for Vaccine Preventable Diseases, and.,University Health Network, Toronto, Ontario, Canada.,Contributed equally as co-senior authors
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada; .,Dalla Lana School of Public Health.,Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation.,Division of Pediatric Medicine and.,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada.,Contributed equally as co-senior authors
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11
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Gilca R, Billard MN, Zafack J, Papenburg J, Boucher FD, Charest H, Rochette M, De Serres G. Effectiveness of palivizumab immunoprophylaxis to prevent respiratory syncytial virus hospitalizations in healthy full-term <6-month-old infants from the circumpolar region of Nunavik, Quebec, Canada. Prev Med Rep 2020; 20:101180. [PMID: 32953425 PMCID: PMC7484550 DOI: 10.1016/j.pmedr.2020.101180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/06/2020] [Accepted: 08/14/2020] [Indexed: 11/25/2022] Open
Abstract
In Quebec, Canada, eligibility for palivizumab (PVZ) immunoprophylaxis was expanded in fall 2016 to include healthy-full-term (HFT) infants residing in the circumpolar region of Nunavik and aged <3 months at the start of the RSV season or born during the season. This study assessed the effectiveness of PVZ to prevent RSV hospitalizations in these infants during the 3 seasons following its implementation. Medical and laboratory records of <1-year-old infants (375 average annual birth cohort) admitted to regional and tertiary hospitals with respiratory infection during 6 years were reviewed. Individual pharmacy data and birth registries were used to estimate adherence to PVZ and direct PVZ effectiveness in 0-5-month-old HFT infants by comparing the incidence of RSV hospitalizations 1) in protected and unprotected infants, and 2) during PVZ-protected and unprotected days. Over six seasons, the RSV hospitalization rate was 50.2/1000 (72.6/1000 adjusted for underdetection) in <1-year-old infants. PVZ was administered to 73% (469) of eligible HFT infants; 37% (237) received all recommended doses. Overall for the three RSV seasons the incidence of RSV hospitalization in PVZ-protected infants was similar to PVZ-unprotected infants, resulting in PVZ direct effectiveness of -6.7% (95% CI -174.8%, 85.6%). The incidence of RSV hospitalization during PVZ-protected and during PVZ-unprotected days was also similar, resulting in PVZ direct effectiveness of -3.8% (CI -167.6%, 64.9%). Over three RSV seasons, there was no evidence that PVZ reduced RSV hospitalizations in HFT Nunavik infants. In addition, the sub-optimal adherence to the recommended PVZ administration schedule suggests feasibility and acceptability issues.
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Affiliation(s)
- Rodica Gilca
- Institut National de Santé Publique du Québec, Quebec-City, Quebec, Canada
- Centre de recherche du CHU de Québec-Université Laval, Quebec-City, Quebec, Canada
| | - Marie-Noëlle Billard
- Centre de recherche du CHU de Québec-Université Laval, Quebec-City, Quebec, Canada
| | - Joseline Zafack
- Centre de recherche du CHU de Québec-Université Laval, Quebec-City, Quebec, Canada
| | - Jesse Papenburg
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - François D. Boucher
- Centre de recherche du CHU de Québec-Université Laval, Quebec-City, Quebec, Canada
| | - Hugues Charest
- Laboratoire de santé publique du Québec, Institut National de Santé Publique du Québec, Montreal, Quebec, Canada
| | - Marie Rochette
- Nunavik Regional Board of Health and Social Services, Kuujjuaq, Quebec, Canada
| | - Gaston De Serres
- Institut National de Santé Publique du Québec, Quebec-City, Quebec, Canada
- Centre de recherche du CHU de Québec-Université Laval, Quebec-City, Quebec, Canada
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12
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Elawar F, Oraby AK, Kieser Q, Jensen LD, Culp T, West FG, Marchant DJ. Pharmacological targets and emerging treatments for respiratory syncytial virus bronchiolitis. Pharmacol Ther 2020; 220:107712. [PMID: 33121940 DOI: 10.1016/j.pharmthera.2020.107712] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/21/2020] [Indexed: 12/20/2022]
Abstract
RSV infection of the lower respiratory tract in infants is the leading cause of pediatric hospitalizations and second to malaria in causing infant deaths worldwide. RSV also causes substantial morbidity in immunocompromised and elderly populations. The only available therapeutic is a prophylactic drug called Palivizumab that is a humanized monoclonal antibody, given to high-risk infants. However, this intervention is expensive and has a limited impact on annual hospitalization rates caused by RSV. No vaccine is available, nor are efficacious antivirals to treat an active infection, and there is still no consensus on how infants with bronchiolitis should be treated during hospital admission. In this comprehensive review, we briefly outline the function of the RSV proteins and their suitability as therapeutic targets. We then discuss the most promising drug candidates, their inhibitory mechanisms, and whether they are in the process of clinical trials. We also briefly discuss the reasons for some of the failures in RSV therapeutics and vaccines. In summary, we provide insight into current antiviral development and the considerations toward producing licensed antivirals and therapeutics.
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Affiliation(s)
- Farah Elawar
- Li Ka Shing Institute of Virology, Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Ahmed K Oraby
- Department of Chemistry, University of Alberta, Edmonton, Alberta T6G 2G2, Canada; Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Misr University for Science &Technology, Al-Motamayez District, 6th of October City, P.O. Box 77, Egypt
| | - Quinten Kieser
- Li Ka Shing Institute of Virology, Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Lionel D Jensen
- Li Ka Shing Institute of Virology, Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Tyce Culp
- Li Ka Shing Institute of Virology, Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Frederick G West
- Department of Chemistry, University of Alberta, Edmonton, Alberta T6G 2G2, Canada
| | - David J Marchant
- Li Ka Shing Institute of Virology, Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2R3, Canada.
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13
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Zhang S, Akmar LZ, Bailey F, Rath BA, Alchikh M, Schweiger B, Lucero MG, Nillos LT, Kyaw MH, Kieffer A, Tong S, Campbell H, Beutels P, Nair H, Nair H, Campbell H, Shi T, Zhang S, Li Y, Openshaw P, A Wedzicha J, R Falsey A, Miller M, Beutels P, Antillon M, Bilcke J, Li X, Bont L, Pollard A, Molero E, Martinon-Torres F, Heikkinen T, Meijer A, Fischer TK, van den Berge M, Giaquinto C, Mikolajczyk R, Hackett J, Tafesse E, Lopez AG, Dieussaert I, Dermateau N, Stoszek S, Gallichan S, Kieffer A, Demont C, Cheret A, Gavart S, Aerssens J, Wyffels V, Cleenewerck M, Fuentes R, Rosen B, Nair H, Campbell H, Shi T, Zhang S, Li Y, Openshaw P, A Wedzicha J, R Falsey A, Miller M, Beutels P, Antillon M, Bilcke J, Li X, Bont L, Pollard A, Molero E, Martinon-Torres F, Heikkinen T, Meijer A, Fischer TK, van den Berge M, Giaquinto C, Mikolajczyk R, Hackett J, Tafesse E, Lopez AG, Dieussaert I, Dermateau N, Stoszek S, Gallichan S, Kieffer A, Demont C, Cheret A, Gavart S, Aerssens J, Wyffels V, Cleenewerck M, Fuentes R, Rosen B. Cost of Respiratory Syncytial Virus-Associated Acute Lower Respiratory Infection Management in Young Children at the Regional and Global Level: A Systematic Review and Meta-Analysis. J Infect Dis 2020; 222:S680-S687. [DOI: 10.1093/infdis/jiz683] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory infection (ALRI) in young children aged <5 years.
Methods
We aimed to identify the global inpatient and outpatient cost of management of RSV-ALRI in young children to assist health policy makers in making decisions related to resource allocation for interventions to reduce severe morbidity and mortality from RSV in this age group. We searched 3 electronic databases including Global Health, Medline, and EMBASE for studies reporting cost data on RSV management in children under 60 months from 2000 to 2017. Unpublished data on the management cost of RSV episodes were collected through collaboration with an international working group (RSV GEN) and claim databases.
Results
We identified 41 studies reporting data from year 1987 to 2017, mainly from Europe, North America, and Australia, covering the management of a total of 365 828 RSV disease episodes. The average cost per episode was €3452 (95% confidence interval [CI], 3265–3639) and €299 (95% CI, 295–303) for inpatient and outpatient management without follow-up, and it increased to €8591(95% CI, 8489–8692) and €2191 (95% CI, 2190–2192), respectively, with follow-up to 2 years after the initial event.
Conclusions
Known risk factors (early and late preterm birth, congenital heart disease, chronic lung disease, intensive care unit admission, and ventilator use) were associated with €4160 (95% CI, 3237–5082) increased cost of hospitalization. The global cost of inpatient and outpatient RSV ALRI management in young children in 2017 was estimated to be approximately €4.82 billion (95% CI, 3.47–7.93), 65% of these in developing countries and 55% of global costs accounted for by hospitalization. We have demonstrated that RSV imposed a substantial economic burden on health systems, governments, and the society.
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Affiliation(s)
- Shanshan Zhang
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Lily Zainal Akmar
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Freddie Bailey
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Brunhilde Schweiger
- National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany
| | - Marilla G Lucero
- Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines
| | - Leilani T Nillos
- Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines
| | - Moe H Kyaw
- Sanofi Pasteur, Swiftwater, Pennsylvania, USA
| | | | | | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- ReSViNET Foundation, Zeist, The Netherlands
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Farrow S, Agarwal A, Saban J, Scott D, Barrowman N, Kovesi T. Oral aspiration, type 1 laryngeal cleft, and respiratory tract infections in canadian inuit children. Pediatr Pulmonol 2019; 54:1837-1843. [PMID: 31313533 DOI: 10.1002/ppul.24447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/18/2019] [Indexed: 01/20/2023]
Abstract
Canadian Inuit infants suffer the highest rate of lower respiratory tract infections (LRTI's) in the world. The causes of this are incompletely understood. The primary objective of this study was to determine whether there exists an association between respiratory morbidity and oral aspiration in Inuit children. A retrospective chart review was conducted including children from Nunavut who underwent Video Fluoroscopic Swallowing Study between the years of 2001 to 2015. The primary outcome was hospitalization for LRTI. We hypothesized that infants found to have aspiration would experience a higher rate of admissions for LRTI than those with normal swallowing studies. One-hundred and twenty-seven patients were identified, of whom 94 were included. Fifty-six percent of patients had an abnormal swallowing study. Compared with patients with normal swallowing, the incidence rate of LRTI was higher in patients with aspiration (incidence rate ratio [IRR] = 1.51; 95% confidence interval [CI] = 1.23-1.87) and in patients with penetration (IRR = 1.40; 95% CI = 1.11-1.76). Fourteen percent of patients had confirmed laryngeal cleft; patients with confirmed presence of this also had a higher incidence rate of LRTI (IRR = 1.66; 95% CI = 1.32-2.07). The incidence of abnormal swallowing study showed an 11-fold variation across the five regions in Nunavut, with the highest prevalence in west Qikiqtani Region (Baffin Island). We conclude that swallowing dysfunction is not only prevalent amongst Canadian Inuit but clinically significant. This is the first study to demonstrate an association between swallowing dysfunction and respiratory morbidity in this population. Geographic distribution patterns and high rates of laryngeal cleft may point to a potential genetic etiology for what remains at this point, idiopathic swallowing dysfunction.
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Affiliation(s)
- Sarah Farrow
- Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Amisha Agarwal
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jeremy Saban
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Darcy Scott
- Stanton Territorial Hospital, Yellowknife, Northwest Territories, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Thomas Kovesi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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15
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Ginsberg GM, Somekh E, Schlesinger Y. Should we use Palivizumab immunoprophylaxis for infants against respiratory syncytial virus? - a cost-utility analysis. Isr J Health Policy Res 2018; 7:63. [PMID: 30554570 PMCID: PMC6296113 DOI: 10.1186/s13584-018-0258-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/18/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Passive immunization against RSV (Respiratory Syncytial Virus) is given in most western countries (including Israel) to infants of high risk groups such as premature babies, and infants with Congenital Heart Disease or Congenital Lung Disease. However, immunoprophylaxis costs are extremely high ($2800-$4200 per infant). Using cost-utility analysis criteria, we evaluate whether it is justified to expand, continue or restrict nationwide immunoprophylaxis using palivizumab of high risk infants against RSV. METHODS Epidemiological, demographic, health service utilisation and economic data were integrated from primary (National Hospitalization Data, etc.) and secondary data sources (ie: from published articles) into a spread-sheet to calculate the cost per averted disability-adjusted life year (DALY) of vaccinating various infant risk groups. Costs of intervention included antibody plus administration costs. Treatment savings and DALYs averted were estimated from applying vaccine efficacy data to relative risks of being hospitalised and treated for RSV, including possible long-term sequelae like asthma and wheezing. RESULTS For all the groups RSV immunoprophylaxis is clearly not cost effective as its cost per averted DALY exceeds the $105,986 guideline representing thrice the per capita Gross Domestic Product. Vaccine price would have to fall by 48.1% in order to justify vaccinating Congenital Heart Disease or Congenital Lung Disease risk groups respectively on pure cost-effectiveness grounds. For premature babies of < 29 weeks, 29-32 and 33-36 weeks gestation, decreases of 36.8%, 54.5% and 83.3% respectively in vaccine price are required. CONCLUSIONS Based solely on cost-utility analysis, at current price levels it is difficult to justify the current indications for passive vaccination with Palivizumab against RSV. However, if the manufacturers would reduce the price by 54.5% then it would be cost-effective to vaccinate the Congenital Heart Disease or Congenital Lung Disease risk groups as well as premature babies born before the 33rd week of gestation.
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Affiliation(s)
- Gary M. Ginsberg
- Department of Technology Assessment, Public Health Service, Ministry of Health, Jerusalem, Israel
| | - Eli Somekh
- Department of Pediatrics, Wolfson Hospital, Holon, and Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany
| | - Yechiel Schlesinger
- Department of Pediatrics, Shaarae Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
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16
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Sruamsiri R, Kubo H, Mahlich J. Hospitalization costs and length of stay of Japanese children with respiratory syncytial virus: A structural equation modeling approach. Medicine (Baltimore) 2018; 97:e11491. [PMID: 30024527 PMCID: PMC6086555 DOI: 10.1097/md.0000000000011491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study sought to identify factors that impact the total health care costs associated with hospitalization of young Japanese children with respiratory syncytial virus (RSV). METHODS Children admitted between April 2014 and March 2015 with at least a confirmed diagnosis of RSV and 2 days of hospital stay were considered for inclusion. Data analyses of hospital claims were performed using a structural equation modeling approach. RESULTS A total of 6811 Japanese inpatients (<5 years old) diagnosed with RSV were included. The average length of stay was 7.5 days with a mean total health care cost of US Dollars (USD) $3344 per hospitalization. Intensive care unit hospitalizations were associated with greater costs (USD +$4951) compared to routine hospitalizations. The highest procedure-related cost drivers were blood transfusions (USD +$6402) and tube feedings (USD +$3512). CONCLUSION The economic burden of RSV-related infection hospitalizations in Japan is considerable. Efforts should be toward immunization and therapeutic treatment strategies that reduce severity, prevent, or reduce the duration of hospitalization.
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Affiliation(s)
- Rosarin Sruamsiri
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan
- Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand
| | - Hiroshi Kubo
- Research and Development Department, Janssen Pharmaceutical KK, Tokyo, Japan
| | - Jörg Mahlich
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan
- Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany
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17
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O’Reilly D, Gaebel K, Xie F, Tarride JE, Goeree R. Health economic evaluations help inform payers of the best use of scarce health care resources. Int J Circumpolar Health 2016. [DOI: 10.3402/ijch.v70i4.17843] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
BACKGROUND Aboriginal infants are at risk for serious respiratory infection. OBJECTIVE To determine the hazard rate (HR) for respiratory-related illness (RIH) and respiratory syncytial virus (RSV) specific infection hospitalization (RSVH) in Aboriginal versus non-Aboriginal children receiving palivizumab and the effect of adherence on hospitalization. METHODS Palivizumab recipients in the Canadian registry from 2005 to 2014 were included. Adherence was determined by the number of palivizumab doses received during the RSV season and interdose time interval. Adherence proportions between groups were compared by χ test. Cox proportional hazard analysis determined the effect of Aboriginal status and adherence on the risk of RIH and RSVH. RESULTS Aboriginal infants comprised 3.6% (701/19,235) of the registry. HR was 1.6 [95% confidence interval (CI): 1.3-2.0, P < 0.001] and 1.2 (95% CI: 0.7-2.2, P = 0.383) for RIH and RSVH. Aboriginal infants were 62.8% and 63.3% adherent with all recommended injections and within stipulated time intervals, respectively, whereas 81.9% (χ = 162.45, df = 1, P < 0.001) and 72.4% (χ = 27.35, df = 1, P = 0.002) of non-Aboriginal infants were correspondingly adherent. Only 39.9% of Aboriginals were perfectly adherent (adherent to total number and injection intervals), compared with 61.7% of non-Aboriginals (χ = 133.89, df = 1, P < 0.001). Even after adjustment for known risk factors, being Aboriginal and nonadherent was associated with higher RIH hazard (HR = 1.4, 95% CI: 1.1-1.8; HR = 1.3, 95% CI: 1.1-1.4, P = 0.004), respectively. Aboriginals nonadherent with interdose intervals had a 2.2-fold increased HR for RSVH (HR = 2.2, 95% CI: 1.2-4.2, P = 0.015). CONCLUSIONS Prophylaxed Aboriginal infants have a significantly increased RIH and RSVH hazard than non-Aboriginal infants. Improving adherence especially interdose frequency may further reduce hospitalizations in this vulnerable population.
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Banerji A, Ng K, Moraes TJ, Panzov V, Robinson J, Lee BE. Cost-effectiveness of palivizumab compared to no prophylaxis in term infants residing in the Canadian Arctic. CMAJ Open 2016; 4:E623-E633. [PMID: 28443266 PMCID: PMC5396468 DOI: 10.9778/cmajo.20150052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hospital admissions for respiratory syncytial virus infection result in large health expenditures for Inuit infants. Palivizumab has been shown to be highly effective in reducing such admissions in preterm Inuit infants. We performed a cost-effectiveness analysis estimating the incremental cost-effectiveness ratio (ICER) for palivizumab prophylaxis per admission related to respiratory syncytial virus avoided in healthy term infants across the Canadian Arctic. METHODS We compared universal palivizumab prophylaxis in term infants less than 6 months of age to no prophylaxis in 8 Arctic regions: the Northwest Territories, Nunavut, Nunavut without Iqaluit, the 3 subregions of Nunavut (Kitikmeot, Kivalliq and Qikiqtaaluk), the Qikiqtaaluk Region without Iqaluit, and Nunavik (northern Quebec). Costs were acquired from the territorial governments, hospitals and contracted agencies. The perspective is that of the public payer, with a 6-month timeline. In scenario A, universal prophylaxis was provided until the end of the respiratory syncytial virus season, and in scenario B, infants received prophylaxis until 5 months of age. The ICERs of scenario A were compared with those of scenario B. RESULTS Under scenario A, the cost per admission avoided was as high as $546 115 in the Northwest Territories, compared with a cost savings of $36 145 in the Kitikmeot Region. Under scenario B, the ICER showed cost savings of $48 549 in the Kitikmeot Region and $2731 in the Kivalliq Region, with low ICERs in Nunavik of $15 601. INTERPRETATION Considerable cost savings were found for the Kitikmeot Region with universal palivizumab prophylaxis in term infants with both scenarios, whereas cost savings were found for the Kivalliq Region with scenario B. Stopping prophylaxis at 5 months of age was a more cost-effective strategy in all regions except the Kitikmeot Region. Nunavik had low ICERs, and prophylaxis should be considered for this region.
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Affiliation(s)
- Anna Banerji
- Li Ka Shing Knowledge Institute (Banerji), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Ng), University of Calgary, Calgary, Alta.; Hospital for Sick Children (Moraes); Applied Health Research Centre (Panzov), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Stollery Children's Hospital (Robinson) and Department of Pediatrics (Lee), Faculty of Medicine, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Kaspar Ng
- Li Ka Shing Knowledge Institute (Banerji), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Ng), University of Calgary, Calgary, Alta.; Hospital for Sick Children (Moraes); Applied Health Research Centre (Panzov), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Stollery Children's Hospital (Robinson) and Department of Pediatrics (Lee), Faculty of Medicine, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Theo J Moraes
- Li Ka Shing Knowledge Institute (Banerji), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Ng), University of Calgary, Calgary, Alta.; Hospital for Sick Children (Moraes); Applied Health Research Centre (Panzov), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Stollery Children's Hospital (Robinson) and Department of Pediatrics (Lee), Faculty of Medicine, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Vladimir Panzov
- Li Ka Shing Knowledge Institute (Banerji), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Ng), University of Calgary, Calgary, Alta.; Hospital for Sick Children (Moraes); Applied Health Research Centre (Panzov), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Stollery Children's Hospital (Robinson) and Department of Pediatrics (Lee), Faculty of Medicine, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Joan Robinson
- Li Ka Shing Knowledge Institute (Banerji), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Ng), University of Calgary, Calgary, Alta.; Hospital for Sick Children (Moraes); Applied Health Research Centre (Panzov), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Stollery Children's Hospital (Robinson) and Department of Pediatrics (Lee), Faculty of Medicine, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Bonita E Lee
- Li Ka Shing Knowledge Institute (Banerji), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Ng), University of Calgary, Calgary, Alta.; Hospital for Sick Children (Moraes); Applied Health Research Centre (Panzov), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Stollery Children's Hospital (Robinson) and Department of Pediatrics (Lee), Faculty of Medicine, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
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Banerji A, Panzov V, Young M, Robinson J, Lee B, Moraes T, Mamdani M, Giles BL, Jiang D, Bisson D, Dennis M, Morel J, Hall J, Hui C, Paes B, Mahony JB. Hospital admissions for lower respiratory tract infections among infants in the Canadian Arctic: a cohort study. CMAJ Open 2016; 4:E615-E622. [PMID: 28018874 PMCID: PMC5173479 DOI: 10.9778/cmajo.20150051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It is unknown whether this burden of disease of lower respiratory tract infections is comparable across the Canadian Arctic. The objectives of this surveillance study were to compare the rates of hospital admission for lower respiratory tract infection and the severity of infection across Arctic Canada, and to describe the responsible viruses. METHODS We performed a prospective multicentre surveillance study of infants less than 1 year of age admitted in 2009 with lower respiratory tract infection to all hospitals (5 regional, 4 tertiary) in the Northwest Territories, Nunavut and Nunavik to assess for regional differences. Nasopharyngeal aspirates were processed by means of a polymerase chain reaction respiratory viral panel, testing for 20 respiratory viruses and influenza A (H1N1). The role of coinfection was assessed by means of regression analysis for length of stay (short: < 7 d; long: > 14 d). Outcomes compared included rates of lower respiratory tract infection, respiratory syncytial virus infection, transfer to tertiary hospital and severe lower respiratory tract infection (respiratory failure, intubation and mechanical ventilation, and/or cardiopulmonary resuscitation). RESULTS There were 348 admissions for lower respiratory tract infection in the population of interest in 2009. Rates of admission per 1000 live births varied significantly, from 39 in the Northwest Territories to 456 in Nunavik (p < 0.001). The rates of tertiary admissions and severe lower respiratory tract infection per 1000 live births in the Northwest Territories were 5.6 and 1.4, respectively, compared to 55.9 and 17.1, respectively, in Nunavut and 52.0 and 20.0, respectively, in Nunavik (p ≤ 0.001). Respiratory syncytial virus was the most common virus identified (124 cases [41.6% of those tested]), and coinfection was detected in 51 cases (41.1%) of infection with this virus. Longer length of stay was associated with coinfection (odds ratio [OR] 2.64) and underlying risk factors (OR 4.39). Length of stay decreased by 32.2% for every 30-day increase in age (OR 0.68). INTERPRETATION Nunavut and Nunavik have very elevated rates of lower respiratory tract infection, with severe outcomes. Respiratory syncytial virus was the most common virus identified, and coinfection was associated with longer length of stay. Targeted public health interventions are required to reduce the burden of disease for infants residing in these Arctic regions.
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Affiliation(s)
- Anna Banerji
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - Val Panzov
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - Michael Young
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - Joan Robinson
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - Bonita Lee
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - Theo Moraes
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - B Louise Giles
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - Depeng Jiang
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - Danny Bisson
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - Marguerite Dennis
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - Johanne Morel
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - Judith Hall
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - Charles Hui
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - Bosco Paes
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
| | - James B Mahony
- Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont
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O'Brien KL, Chandran A, Weatherholtz R, Jafri HS, Griffin MP, Bellamy T, Millar EV, Jensen KM, Harris BS, Reid R, Moulton LH, Losonsky GA, Karron RA, Santosham M. Efficacy of motavizumab for the prevention of respiratory syncytial virus disease in healthy Native American infants: a phase 3 randomised double-blind placebo-controlled trial. THE LANCET. INFECTIOUS DISEASES 2015; 15:1398-408. [PMID: 26511956 DOI: 10.1016/s1473-3099(15)00247-9] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections in children. We aimed to assess the safety and efficacy of an anti-RSV monoclonal antibody (motavizumab) in healthy term (≥36 weeks' gestational age) infants for the prevention of medically attended RSV acute lower respiratory tract infections. METHODS This phase 3, double-blind, placebo-controlled, randomised trial enrolled healthy Native American infants aged 6 months or younger who were born at 36 weeks' gestational age in southwestern USA, on the Navajo Nation, the White Mountain Apache reservation, and the San Carlos Apache Indian reservation. Participants were randomly assigned (2:1) to receive either five monthly intramuscular doses of motavizumab (15 mg/kg) or placebo. They were followed up for 150 days after the first dose, and the primary endpoints were respiratory admission to hospital with a positive result for RSV by RT-PCR and death caused by RSV. Participants were followed up for medically attended wheezing until they reached age 3 years. Analysis was by intention to treat (ITT). This trial is registered with ClinicalTrials.gov, number NCT00121108. FINDINGS During the autumn seasons (October to December) between 2004 and 2007, 2127 infants of the 2596 infants enrolled were randomly assigned to receive either motavizumab (1417) or placebo (710). After ITT analysis, motavizumab resulted in an 87% relative reduction (relative risk [RR] 0·13, 95% CI 0·08-0·21) in the proportion of infants admitted to hospital with RSV (21 [2%] of 1417 participants who received motavizumab; 80 [11%] of 710 participants who received placebo, p<0·0001). Serious adverse events were less common in particpants taking motavizumab (212 [15%]) than particpants on placebo (148 [21%]). Six deaths occurred in study participants (motavizumab, n=4 [0·3%]; placebo, n=2 [0·3%]); none were deemed to be related to the study product. Hypersensitivity events were more common in patients given motavizumab (208 [14·7%]) than in placebo recipients (87 [12·3%]; p=0·14). There was no effect on rates of medically attended wheezing in children aged 1-3 years (190 [14·9%] of participants randomly assigned to receive motavizumab vs 90 [14·0%] participants randomly assigned to receive placebo). INTERPRETATION To our knowledge, this is the only trial of an anti-RSV antibody to prevent serious RSV disease in healthy term infants. Motavizumab significantly reduced the RSV-associated inpatient and outpatient burden and set a benchmark for the efficacy of RSV prevention strategies. The findings do not support a direct, generalisable, causal association between RSV lower respiratory tract infection and subsequent long-term wheezing in term infants. FUNDING MedImmune.
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Affiliation(s)
- Katherine L O'Brien
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Aruna Chandran
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert Weatherholtz
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Eugene V Millar
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Raymond Reid
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence H Moulton
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ruth A Karron
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mathuram Santosham
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Eighteen Years of Respiratory Syncytial Virus Surveillance: Changes in Seasonality and Hospitalization Rates in Southwestern Alaska Native Children. Pediatr Infect Dis J 2015; 34:945-50. [PMID: 26065863 PMCID: PMC6931377 DOI: 10.1097/inf.0000000000000772] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alaska Native infants from the Yukon-Kuskokwim Delta (YKD) experienced respiratory syncytial virus (RSV) hospitalization rates 5 times higher and an RSV season twice as long as the general US infant population. We describe trends in hospitalization rates and seasonality during 18 years of continuous RSV surveillance in this population and explore contributions of climate and sociodemographic factors. METHODS We abstracted clinical and RSV test information from computerized medical records at YKD Regional Hospital and Alaska Native Medical Center from 1994 to 2012 to determine hospitalization rates and RSV season timing. Descriptive village and weather data were acquired through the US Census and Alaska Climate Research Center, University of Alaska, Fairbanks, respectively. RESULTS During 1994-2012, YKD infant RSV hospitalization rates declined nearly 3-fold, from 177 to 65 per 1000 infants/yr. RSV season onset shifted later, from mid October to late December, contributing to a significantly decreased season duration, from 30 to 11 weeks. In a multivariate analysis, children from villages with more crowded households and lacking plumbed water had higher rates of RSV hospitalizations (relative rate, 1.17; P = 0.0005 and relative rate, 1.45; P = 0.0003). No association of temperature or dew point was found with the timing or severity of RSV season. CONCLUSIONS Although the RSV hospitalization rate decreased 3-fold, YKD infants still experience a hospitalization rate 3-fold higher than the general US infant population. Overcrowding and lack of plumbed water were associated with RSV hospitalization. Dramatic changes occurred in RSV seasonality, not explained by changes in climate.
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Borse RH, Singleton RJ, Bruden DT, Fry AM, Hennessy TW, Meltzer MI. The Economics of Strategies to Reduce Respiratory Syncytial Virus Hospitalizations in Alaska. J Pediatric Infect Dis Soc 2014; 3:201-12. [PMID: 26625383 DOI: 10.1093/jpids/pit072] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/19/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Alaska Native infants experience high rates of respiratory syncytial virus (RSV) hospitalizations. Through 2008, Alaska administered a 7-dose (maximum) palivizumab regime to high-risk infants from October to May. In 2009, the maximum was reduced to 3 doses for 32- to 34-week preterm babies and 6 doses for other groups. METHODS We used 11 years of data and regional Medicaid reimbursement rates to model the cost effectiveness of 4 palivizumab intervention strategies to reduce RSV hospitalizations among Alaskan infants including: current strategy, old strategy (1998-2008), and 2 hypothetical strategies using the current strategy plus 1 or 3 doses to all newborn infants during the RSV season. RESULTS The current strategy represents 5 hospitalizations averted per year for the palivizumab cohort (∼50-56 children) at ∼$52 846 per hospitalization averted, compared with no intervention. Compared with the old strategy, the mean cost per hospitalization prevented for the current strategy was 63% lower, net program costs were 85% lower, and the mean hospitalizations prevented were 27% lower. Compared with current strategy only, the addition of 1 dose to all newborns during the RSV season could decrease the mean cost per hospitalization prevented by 23%, increase the number of hospitalizations prevented by 2.5-fold, and increase the net programmatic costs by 3.3-fold; administering up to 3 doses to infants further reduced hospitalizations and increased costs. CONCLUSIONS The current palivizumab strategy improved the cost-effectiveness ratio compared with the old strategy. Further improvement could be obtained by adding doses for Alaskan Native newborns during the RSV season; however, programmatic costs would increase.
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Affiliation(s)
| | - Rosalyn J Singleton
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases
| | - Dana T Bruden
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases
| | - Alicia M Fry
- Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas W Hennessy
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases
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Are we too passive in our attempts to prevent respiratory syncytial virus infection in Northern Canada? Can Respir J 2014; 21:163-4. [PMID: 24914608 DOI: 10.1155/2014/258504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Singleton RJ, Valery PC, Morris P, Byrnes CA, Grimwood K, Redding G, Torzillo PJ, McCallum G, Chikoyak L, Mobberly C, Holman RC, Chang AB. Indigenous children from three countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis. Pediatr Pulmonol 2014; 49:189-200. [PMID: 23401398 DOI: 10.1002/ppul.22763] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/13/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Indigenous children in developed countries are at increased risk of chronic suppurative lung disease (CSLD), including bronchiectasis. We evaluated sociodemographic and medical factors in indigenous children with CSLD/bronchiectasis from Australia, United States (US), and New Zealand (NZ). METHODS Indigenous children aged 0.5-8 years with CSLD/bronchiectasis were enrolled from specialist clinics in Australia (n = 97), Alaska (n = 41), and NZ (n = 42) during 2004-2009, and followed for 1-5 years. Research staff administered standardized parent interviews, reviewed medical histories and performed physical examinations at enrollment. RESULTS Study children in all three countries had poor housing and sociodemographic circumstances at enrollment. Except for increased household crowding, most poverty indices in study participants were similar to those reported for their respective local indigenous populations. However, compared to their local indigenous populations, study children were more often born prematurely and had both an increased frequency and earlier onset of acute lower respiratory infections (ALRIs). Most (95%) study participants had prior ALRI hospitalizations and 77% reported a chronic cough in the past year. Significant differences (wheeze, ear disease and plumbed water) between countries were present. DISCUSSION Indigenous children with CSLD/bronchiectasis from three developed countries experience significant disparities in poverty indices in common with their respective indigenous population; however, household crowding, prematurity and early ALRIs were more common in study children than their local indigenous population. Addressing equity, especially by preventing prematurity and ALRIs, should reduce risk of CSLD/bronchiectasis in indigenous children.
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Affiliation(s)
- Rosalyn J Singleton
- Alaska Native Tribal Health Consortium, Anchorage, Alaska; Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Anchorage, Alaska.
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Hussman JM, Li A, Paes B, Lanctôt KL. A review of cost–effectiveness of palivizumab for respiratory syncytial virus. Expert Rev Pharmacoecon Outcomes Res 2014; 12:553-67. [DOI: 10.1586/erp.12.45] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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The real-life effectiveness of palivizumab for reducing hospital admissions for respiratory syncytial virus in infants residing in Nunavut. Can Respir J 2013; 21:185-9. [PMID: 24367792 DOI: 10.1155/2014/941367] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED BACKGROUND⁄ OBJECTIVE Nunavut has the highest hospitalization rates for respiratory syncytial virus (RSV) worldwide, with rates of 166 per 1000 live births per year <1 year of age. Palivizumab was implemented in Nunavut primarily for premature infants, or those with hemodynamically significant cardiac or chronic lung disease; however, the effectiveness of the program is unknown. The objective of the present multisite, hospital-based surveillance study was to estimate the effectiveness of palivizumab in infants <6 months of age in Nunavut for the 2009 and 2010 RSV seasons. METHODS Infants identified as palivizumab candidates who were <6 months of age were compared with all admissions for lower respiratory tract infection through multisite, hospital-based surveillance documenting the adequacy of palivizumab prophylaxis, admission for lower respiratory tract infection and the results of RSV testing. The OR for RSV admission in unprophylaxed infants was compared with those who were prophylaxed, and the effectiveness of palivizumab was estimated. RESULTS Within the study cohort (n=101) during the two RSV seasons, five of the 10 eligible infants who did not receive adequate prophylaxis were admitted with RSV while two of the 91 infants <6 months of age eligible for palivizumab who were adequately prophylaxed were hospitalized with RSV (OR 22.3 [95% CI 3.8 to 130]; P=0.0005). The estimated effectiveness of palivizumab for the cohort was as high as 96%. Eight eligible infants were missed by the program and did not receive prophylaxis. CONCLUSION Palivizumab was highly effective in reducing hospitalizations due to RSV infection in Nunavut. Further efforts need to be made to ensure that all eligible infants are identified.
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Andabaka T, Nickerson JW, Rojas-Reyes MX, Rueda JD, Vrca VB, Barsic B. Monoclonal antibody for reducing the risk of respiratory syncytial virus infection in children. ACTA ACUST UNITED AC 2013. [DOI: 10.1002/ebch.1950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Banerji A, Panzov V, Robinson J, Young M, Ng K, Mamdani M. The cost of lower respiratory tract infections hospital admissions in the Canadian Arctic. Int J Circumpolar Health 2013; 72:21595. [PMID: 23967411 PMCID: PMC3748437 DOI: 10.3402/ijch.v72i0.21595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Inuit infants who reside in the Nunavut (NU) regions of Arctic Canada have extremely high rates of lower respiratory tract infections (LRTIs) associated with significant health expenditures, but the costs in other regions of Arctic Canada have not been documented. Objective This prospective surveillance compares, across most of Arctic Canada, the rates and costs associated with LRTI admissions in infants less than 1 year of age, and the days of hospitalization and costs adjusted per live birth. Design This was a hospital-based surveillance of LRTI admissions of infants less than 1 year of age, residing in Northwest Territories (NT), the 3 regions of Nunavut (NU); [Kitikmeot (KT), Kivalliq (KQ) and Qikiqtani (QI)] and Nunavik (NK) from 1 January 2009 to 30 June 2010. Costs were obtained from the territorial or regional governments and hospitals, and included transportation, hospital stay, physician fees and accommodation costs. The rates of LRTI hospitalizations, days of hospitalization and associated costs were calculated per live birth in each of the 5 regions. Results There were 513 LRTI admissions during the study period. For NT, KT, KQ, QI and NK, the rates of LRTI hospitalization per 1000 live births were 38, 389, 230, 202 and 445, respectively. The total days of LRTI admission per live birth were 0.25, 3.3, 2.6, 1.7 and 3 for the above regions. The average cost per live birth for LRTI admission for these regions was $1,412, $22,375, $14,608, $8,254 and $10,333. The total cost for LRTI was $1,498,232 in NT, $15,662,968 in NU and $3,874,881 in NK. Medical transportation contributed to a significant proportion of the costs. Conclusion LRTI admission rates in NU and Nunavik are much higher than that in NT and remain among the highest rates globally. The costs of these admissions are exceptionally high due to the combination of very high rates of admission, very expensive medical evacuations and prolonged hospitalizations. Decreasing the rates of LRTI in this population could result in substantial health savings.
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Affiliation(s)
- Anna Banerji
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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Should respiratory care in preterm infants include prophylaxis against respiratory syncytial virus infection? The case in favour. Paediatr Respir Rev 2013; 14:130-6. [PMID: 23375547 DOI: 10.1016/j.prrv.2012.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Respiratory syncytial virus (RSV) is the most significant cause of acute respiratory tract infections (RTI) in infants and young children throughout the world. Preterm infants are at increased risk for severe RSV lower respiratory tract infection due to small lung volumes, a reduced lung surface area, small airways and an increased air space wall thickness. Additionally, the airways of preterm infants have been ventilated mechanically and suctioned and potentially damaged by many microtraumas with disruption of endothelial surfaces enabling pathogens to invade more easily. The immune system of preterm infants is immature resulting in low antibody titers (incomplete transplacental transfer of maternal antibodies) and a reduced cellular immunity with reduced viral clearance. Rehospitalization rates of preterm compared to term infants due to RSV infection are increased as are total morbidity and mortality associated with RSV disease. Palivizumab effectively reduces RSV related rehospitalisation in this high-risk population.
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Andabaka T, Nickerson JW, Rojas-Reyes MX, Rueda JD, Bacic Vrca V, Barsic B. Monoclonal antibody for reducing the risk of respiratory syncytial virus infection in children. Cochrane Database Syst Rev 2013:CD006602. [PMID: 23633336 DOI: 10.1002/14651858.cd006602.pub4] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is one of the most important viral pathogens causing acute respiratory infections in children. It results in about 3.4 million hospitalisations annually in children under five. Palivizumab is an anti-RSV monoclonal antibody, administered intramuscularly at a dose of 15 mg/kg once every 30 days. The efficacy and safety of palivizumab has been evaluated in multicentre, randomised controlled trials (RCTs) and a large number of economic evaluations (EEs) have tested its cost-effectiveness. OBJECTIVES To assess the effectiveness and safety of palivizumab prophylaxis compared with placebo, or another type of prophylaxis, in reducing the risk of complications (hospitalisation due to RSV infection) in high-risk infants and children. To assess the cost-effectiveness (or cost-utility) of palivizumab prophylaxis compared with no prophylaxis in infants and children in different risk groups. SEARCH METHODS We searched CENTRAL 2012, Issue 7, MEDLINE (1996 to July week 4, 2012), EMBASE (1996 to August 2012), CINAHL (1996 to August 2012) and LILACS (1996 to August 2012) for studies of effectiveness and safety. We searched the NHS Economic Evaluations Database (NHS EED 2012, Issue 4), Health Economics Evaluations Database (HEED, 9 August 2012) and Paediatric Economic Database Evaluations (PEDE, 1980 to 2009), MEDLINE (1996 to July week 4, 2012) and EMBASE (1996 to August 2012) for economic evaluations. SELECTION CRITERIA We included RCTs comparing palivizumab prophylaxis with a placebo, no prophylaxis or another type of prophylaxis in preventing serious lower respiratory tract disease caused by RSV in paediatric patients at high risk. We included cost-effectiveness analyses and cost-utility analyses comparing palivizumab prophylaxis with no prophylaxis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias for the included studies and extracted data for both the RCTs and EEs. We calculated risk ratios (RRs) and their associated 95% confidence intervals (CIs) for dichotomous outcomes and for adverse events (AEs). We provided a narrative summary of results for continuous outcomes, due to missing data on standard deviations. We performed fixed-effect meta-analyses for the estimation of pooled effects whenever there was no indication of heterogeneity between included RCTs. We summarised the results reported in included EEs, such as incremental costs, incremental effectiveness, and incremental cost-effectiveness and/or cost-utility ratios (ICERs), and we calculated ICER present values in 2011 Euros for all studies. MAIN RESULTS Of the seven available RCTs, three compared palivizumab with a placebo in a total of 2831 patients, and four compared palivizumab with motavizumab in a total of 8265 patients. All RCTs were sponsored by the drug manufacturing company. The overall quality of RCTs was good, but for most of the outcomes assessed only data from two studies contributed to the analysis. Palivizumab prophylaxis was associated with a statistically significant reduction in RSV hospitalisations (RR 0.49, 95% CI 0.37 to 0.64) when compared to placebo. When compared to motavizumab, palivizumab recipients showed a non-significant increase in the risk of RSV hospitalisations (RR 1.36, 95% CI 0.97 to 1.90). In both cases, the proportion of children with any AE or any AE related to the study drug was similar between the two groups.In terms of economic evidence, we included 34 studies that reported cost-effectiveness and/or cost-utility data for palivizumab prophylaxis compared with no prophylaxis, in high-risk children with different underlying medical conditions. The overall quality of EEs was good, but the variations in modelling approaches were considerable across the studies, leading to big differences in cost-effectiveness results. The cost-effectiveness of palivizumab prophylaxis depends on the consumption of resources taken into account by the study authors; and on the cost-effectiveness threshold set by the healthcare sector in each country. AUTHORS' CONCLUSIONS There is evidence that palivizumab prophylaxis is effective in reducing the frequency of hospitalisations due to RSV infection, i.e. in reducing the incidence of serious lower respiratory tract RSV disease in children with chronic lung disease, congenital heart disease or those born preterm.Results from economic evaluations of palivizumab prophylaxis are inconsistent, implying that economic findings must be interpreted with caution. ICER values varied considerably across studies, from highly cost-effective to not cost-effective. The availability of low-cost palivizumab would reduce its inequitable distribution, so that RSV prophylaxis would be available to the poorest countries where children are at greatest risk.
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Affiliation(s)
- Tea Andabaka
- School of Medicine, University of Split, Split, Croatia.
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Abstract
A clinician and the chair of the hospital drug committee debate the merits of the use of palivizumab as prophylaxis against respiratory syncytial virus infection for a preterm baby with oxygen-dependent, chronic lung disease and discuss the issue of public funding of palivizumab. An ethicist comments on ethical aspects of the debate about cost-effectiveness.
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Affiliation(s)
- Dominic A Fitzgerald
- Department of Respiratory Medicine Infectious Diseases, Children's Hospital at Westmead, New South Wales, Australia
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Resch B, Kurath S, Manzoni P. Epidemiology of respiratory syncytial virus infection in preterm infants. Open Microbiol J 2011; 5:135-43. [PMID: 22262986 PMCID: PMC3258570 DOI: 10.2174/1874285801105010135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 10/12/2011] [Accepted: 10/27/2011] [Indexed: 01/10/2023] Open
Abstract
This review focuses on the burden of respiratory syncytial virus (RSV) infection in preterm infants with and without chronic lung disease (bronchopulmonary dysplasia, BPD). The year-to-year and seasonal variations in RSV activity are key aspects of RSV epidemiology, and knowledge/monitoring of local RSV activity is mandatory for guidance of prophylaxis with the monoclonal antibodies palivizumab and in the near future motavizumab. Morbidity expressed in rates of hospitalizations attributable to RSV illness revealed a mean of 10 percent in preterm infants without and 19 percent (p=0.016) with BPD. Mortality rates diverged widely, and case fatality rates have been reported to range from 0 to 12 percent. The typical clinical picture of lower respiratory tract infection is not different in term and preterm infants, but rates of apnoeas are significantly increased in preterms, ranging from 4.9 to 37.5 percent with decreasing rates observed in more recent studies. Until a RSV vaccine is developed and will be available, prophylaxis with palivizumab is the only preventative strategy other than hand hygiene and contact measures that significantly reduces RSV hospitalization rates in preterm infants both with and without BPD.
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Affiliation(s)
- Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Division of Neonatology, Pediatric Department, Medical University Graz, Austria
| | - Stefan Kurath
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Division of Neonatology, Pediatric Department, Medical University Graz, Austria
| | - Paolo Manzoni
- Division of Neonatology and NICU, S. Anna Hospital. AO O.I.R.M-S. Anna, Torino, Italy
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Shadman KA, Wald ER. A review of palivizumab and emerging therapies for respiratory syncytial virus. Expert Opin Biol Ther 2011; 11:1455-67. [PMID: 21831008 DOI: 10.1517/14712598.2011.608062] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is an important pathogen in children and adults; however, current treatment options are primarily supportive. Palivizumab, the only approved specific monoclonal antibody for RSV is used prophylactically to reduce morbidity in a select population of high-risk children. AREAS COVERED The development and current use of palivizumab; the potential role of palivizumab as preventive therapy in patients with cystic fibrosis, asthma and compromised immune systems; and explores the limited research in which palivizumab has been used for treatment of RSV. The modified recommendations for the use of palivizumab espoused by the American Academy of Pediatrics and research on the cost-effectiveness of this product are presented. In addition, the authors discuss the development of enhanced monoclonal antibodies including motavizumab, which was recently denied FDA approval for preventative therapy. The authors explore the historical and current efforts to develop a vaccine targeting RSV. The current status of antiviral drug development is also reviewed. The literature search included RSV-Ig, palivizumab, and emerging drugs and vaccines for the treatment of RSV as keywords and titles from 1997 to 2011. EXPERT OPINION Although there are potential drugs and vaccines in development to prevent or reduce the effects of RSV infection, palivizumab remains the only licensed product to reduce the severity of disease in high-risk pediatric patients.
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Affiliation(s)
- Kristin A Shadman
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, 600 Highland Avenue, Box 4108, Madison, WI 53792, USA.
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Paes BA, Mitchell I, Banerji A, Lanctôt KL, Langley JM. A decade of respiratory syncytial virus epidemiology and prophylaxis: translating evidence into everyday clinical practice. Can Respir J 2011; 18:e10-9. [PMID: 21499597 PMCID: PMC3084427 DOI: 10.1155/2011/493056] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a common infection in infancy, with nearly all children affected by two years of age. Approximately 0.5% to 2.0% of all children are hospitalized with lower respiratory tract disease, of which 50% to 90% have bronchiolitis and 5% to 40% have pneumonia. Morbidity and mortality are highest in children with nosocomial infection and in those with underlying medical illnesses such as cardiac and chronic lung disease. Aboriginal children residing in remote northern regions are specifically considered to be at high risk for hospitalization due to RSV infection. Thorough hand washing and health education are the principal strategies in primary prevention. In the absence of a vaccine, palivizumab prophylaxis is currently the best intervention to reduce the burden of illness and RSV-related hospitalization in high-risk children. Health care professionals should provide palivizumab prophylaxis cost effectively in accordance with recommendations issued by pediatric societies and national advisory bodies. The present article reviews the epidemiology of RSV infection and the short- and long-term impact of disease in high-risk infants and special populations. Prevention strategies and treatment are discussed based on the existing scientific evidence, and future challenges in the management of RSV infection are addressed.
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Affiliation(s)
- Bosco A Paes
- Department of Pediatrics, McMaster University, Hamilton, Ontario.
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Paes B, Manzoni P. Special populations: do we need evidence from randomized controlled trials to support the need for respiratory syncytial virus prophylaxis? Early Hum Dev 2011; 87 Suppl 1:S55-8. [PMID: 21273012 DOI: 10.1016/j.earlhumdev.2011.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Congenital abnormalities and impaired mechanisms that govern the normal coordinated physiology of breathing, sucking, swallowing and airway clearance, place infants with underlying medical disorders at high risk for respiratory morbidity following respiratory syncytial virus (RSV) lower respiratory tract infection. The use of RSV prophylaxis in premature infants' ≤ 35 weeks gestational age, infants with chronic lung and hemodynamically significant heart disease is firmly established through randomized controlled clinical trials (RCT's). RSV prophylaxis in infants with serious medical illnesses must be justified based on emerging scientific literature and the overriding concept of achieving a balance between benefit and harm with treatment. This article will explore the current evidence for palivizumab prophylaxis in a variety of disorders and examine existing differences between pediatric advisory body recommendations and real world practice.
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Affiliation(s)
- Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Respiratory Viral Infections. TROPICAL INFECTIOUS DISEASES: PRINCIPLES, PATHOGENS AND PRACTICE 2011. [PMCID: PMC7149827 DOI: 10.1016/b978-0-7020-3935-5.00058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Forbes ML, Hall CB, Jackson A, Masaquel AS, Mahadevia PJ. Comparative costs of hospitalisation among infants at high risk for respiratory syncytial virus lower respiratory tract infection during the first year of life. J Med Econ 2010; 13:136-41. [PMID: 20128663 DOI: 10.3111/13696990903583404] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This retrospective cohort study compared the total cost of hospitalisation due to respiratory syncytial virus (RSV) lower respiratory tract infection (LRI) during the first year of life between late-preterm (33-36 weeks gestational age [wGA]) and term (≥ 37 wGA) infants. RESEARCH DESIGN AND METHODS A large national claims database of commercially insured members was examined to identify hospital admissions associated with RSV between January 2003 and June 2007 among infants at high risk for RSV LRI, including late-preterm infants. Hospital use and costs were compared with those of a reference cohort of term infants with RSV. RESULTS The cost of hospitalisation for RSV among late-preterm infants with at least one hospital admission associated with RSV (n=173) was twice that of term infants (n=1,983; $20,269 vs. 9,635; p< 0.001). The mean length of stay was also higher (5.3 vs. 3.4 days; p< 0.001). Approximately 21.9% of hospitalisations for late-preterm infants included an intensive care unit admission compared with 9.6% among term infants (p< 0.001). LIMITATIONS Reliance on ICD-9 codes to identify potential cohort members may result in misclassification and underreporting the cohort size for conditions of interest. CONCLUSIONS Hospitalisation costs and length of stay due to RSV LRI were significantly greater among late-preterm infants compared with term infants and higher than general estimates previously reported in the broader paediatric population.
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Kuehni CE, Spycher BD, Silverman M. A Role for Genes and Environment in the Causal Relationship between Infant RSV Infection and Childhood Asthma. Am J Respir Crit Care Med 2010. [DOI: 10.1164/ajrccm.181.2.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
OBJECTIVE Palivizumab is a prophylactic therapy shown to reduce the number of respiratory syncytial virus (RSV)-related hospitalizations but has a high acquisition cost. The objective was to systematically examine the cost effectiveness of palivizumab in defined infant groups and identify important cost and outcome determinants. METHODS Literature searches of MedLine, the Cost-Effectiveness Analysis registry and the UK NHS Economic Evaluation Database (NHS EED) were conducted to identify economic evaluations of palivizumab compared to no prophylactic treatment for RSV prevention in any infant population. Study quality was evaluated using Quality of Health Economic Studies (QHES) criteria and results converted to 2009 CAN$ for comparison. RESULTS A total of 23 articles meeting inclusion criteria were identified, including 11 cost-utility analyses (CUAs) and 12 cost-effectiveness analyses (CEAs). Quality of individual analyses was fairly high (range 60-100, median 86). Results ranged from cost dominance for prophylaxis to $3,365,769/QALY depending on population, outcome measures, and input parameters. Base-case and sensitivity-analysis mortality rates varied between studies and influenced results. CONCLUSIONS RSV prophylaxis with palivizumab is cost effective in specific groups of high-risk infants, especially those with multiple environmental risk factors. Cost-effectiveness estimates vary between populations and settings and are more positive in those at highest risk for RSV hospitalization. LIMITATIONS Direct comparison of the published reports was limited by restriction to English language articles and the varied methodologies, input measures, and populations across the studies reviewed. Although reported currencies were converted to a common unit for comparison, this does not completely account for monetary and inflation differences.
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Affiliation(s)
- Kelly A Smart
- Medical Outcomes and Research in Economics (MORE®), Sunnybrook Health Sciences Centre and Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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Samson L. La prévention de l'infection par le virus respiratoire syncytial. Paediatr Child Health 2009. [DOI: 10.1093/pch/14.8.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Respiratory syncytial virus (RSV) infection is the leading cause of lower respiratory tract infection in young children, with significant numbers of premature infants and those with other risk factors requiring hospitalization in Canada each year. Palivizumab, an RSV-specific monoclonal antibody, can reduce the hospitalization rate and severity of illness for a small group of high-risk or premature infants during their first RSV season. The present statement reviews the published literature and provides recommendations regarding its use in premature and other at-risk infants, for Canadian physicians.
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Risk factors and viruses associated with hospitalization due to lower respiratory tract infections in Canadian Inuit children : a case-control study. Pediatr Infect Dis J 2009; 28:697-701. [PMID: 19461554 DOI: 10.1097/inf.0b013e31819f1f89] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine risk factors for lower respiratory tract infections (LRTI) hospital admission in the Canadian Arctic. METHODS This was a case-control study during a 14-month period among children less than 2 years of age. Cases were admitted to the Baffin Regional Hospital in Iqaluit, Nunavut with LRTI. Controls were age matched and came from Iqaluit and 2 communities. Odds ratios (ORs) of hospital admission for LRTI were estimated through multivariate conditional logistic regression modeling for following risk factors: smoking in pregnancy, Inuit race, prematurity, adoption status, breast-feeding, overcrowding, and residing outside of Iqaluit. Viruses in nasophayngeal aspirates were sought at the time of each hospital admission. RESULTS There were 101 age-matched cases and controls. The following risk factors were significantly associated with an increased risk of admission for LRTI (adjusted OR): smoking in pregnancy (OR = 4.0; 95% CI: 1.1-14.6), residence outside of Iqaluit (OR = 2.7; 95% CI: 1.0 -7.2), full Inuit race (OR = 3.8; 95% CI: 1.1-12.8), and overcrowding (OR = 2.5, 95% CI: 1.1- 6.1). Non-breast-fed children had a 3.6-fold risk of being admitted for LRTI (95% CI: 1.2-11.5) and non-breast-fed adopted children had a 4.4-fold increased risk (95% CI: 1.1-17.6) when compared with breast-fed, nonadopted children. Prematurity was not associated with an increased risk of admission. Viruses were identified in 88 (72.7%) of admissions, with respiratory syncytial virus being identified in the majority of admissions, 62 (51.2%). Multiple viruses were isolated in 19 (15.7%) admissions. CONCLUSIONS Smoking during pregnancy, place of residence, Inuit race, lack of breast-feeding, and overcrowding were all independently associated with increased risk of hospital admission for LRTI among Inuit children less than 2 years of age. Future research on the role of adoption and genetics on the health of Inuit children are required.
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Tam DY, Banerji A, Paes BA, Hui C, Tarride JE, Lanctôt KL. The cost effectiveness of palivizumab in term Inuit infants in the Eastern Canadian Arctic. J Med Econ 2009; 12:361-70. [PMID: 19900071 DOI: 10.3111/13696990903442155] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Canadian, Inuit, full term infants have the highest rate of respiratory syncytial virus (RSV) infection globally, which results in substantial costs associated hospitalisation. METHODS Decision-analytical techniques were used to estimate the incremental cost-effectiveness ratio (ICER) for palivizumab compared to no prophylaxis for Inuit infants of all gestational age. The time horizon was that of life-time follow-up, and costs and effectiveness were discounted at 5% per year. Costs (2007 CAD$) for palivizumab, hospitalisation (including medical evacuation, intensive care unit [ICU]), physician visits, and transportation were calculated based on the Canadian payer's perspective. Benefits on decreasing RSV hospitalisation were expressed as quality-adjusted life-years (QALYs). One-way and probabilistic sensitivity analysis (PSA) were conducted, varying: mortality rates, utilities, length of stay in hospital and ICU. RESULTS For all of Baffin Island infants (<1 year), the ICER was $39,435/QALY. However, when infants were grouped by age and area of residence, those residing in Iqaluit (<1 year) had an ICER of $152,145/QALY, while those residing in rural areas (outside of Iqaluit) had an ICER of $24,750/QALY. Prophylaxis was a dominant strategy (cost saving) for rural infants under 6 months of age, with the PSA demonstrating that it was dominant 98% of the time. CONCLUSIONS The ICERs suggested that palivizumab is a cost-effective option for the prevention of RSV for Inuit infants on Baffin Island compared to no prophylaxis. Palivizumab is highly cost effective in Arctic infants <1 year of age specifically residing outside of Iqaluit and is a dominant strategy for those under 6 months of age in rural areas. However, palivizumab is not cost effective compared to no treatment for infants of all ages residing in Iqaluit.
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Affiliation(s)
- Derrick Y Tam
- Medical Outcomes and Research in Economics Group, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada
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