122: Effect of the Revised AAP Statement for Palivizumab Eligibility on Enrolment and Drug Cost in a Retrospective Provincial Cohort of Premature Infants

Abstract

BACKGROUND: Recommendations for palivizumab immunoprophylaxis in premature infants have changed in response to general improvements in outcomes of premature infants and changes in demographic and frequency of RSV-related hospitalization. In August 2014, AAP revised its policy statement limiting palivizumab prophylaxis in premature infants to those <29 weeks gestation. The effect of this change is uncertain but can be estimated on previous cohorts. OBJECTIVES: To assess the impact of the revised eligibility criteria for palivizumab prophylaxis on the number of eligible premature infants and the cost of palivizumab used. DESIGN/METHODS: The Manitoba RSV Immunoprophylaxis Program coordinates RSV immunoprophylaxis for the province of Manitoba. The Program receives notification of all births <35 weeks gestation. Premature infants ≤32 weeks gestation, and 33-35 weeks gestation at high risk for RSV-related hospitalization (based on risk scoring or residing in remote communities) are eligible for immunoprophylaxis. Anonymized data from the three seasons (2011-14) on the number of premature infants enrolled, amount of palivizumab received, and proportional cost of palivizumab was abstracted and reanalyzed applying <29 weeks gestation as cut-off for eligibility. RESULTS: For the three seasons, 672 premature infants (Table 1) were enrolled and received palivizumab. Total cost of palivizumab for this cohort was $2,877,096 (Canadian). Limiting eligibility to <29 weeks gestation reduced enrollment to 113 premature infants with cost of palivizumab of $467,684. Revision to eligibility criteria would have resulted in 559 fewer infants receiving palivizumab and a cost reduction of $2,409,412 over the past three seasons. CONCLUSION: The AAP revised policy statement limiting palivizumab eligibility to premature infants <29 weeks gestation will have a large impact reducing number of premature infants eligible and the cost of palivizumab utilized. In a provincial-based cohort, retrospective application of the new eligibility criteria would have resulted in 559 fewer eligible infants and a cost reduction of $2.4 million over the past three seasons. (Table Presented).