The economic implications of RSV bronchiolitis on the Mid-West

^*F McElligott, ^*A Mirza, ^†S Kinsella, ^*RK Philip

^*Neonatal Intensive Care, Limerick Regional Hospitals, Ireland

^†Department of Economics, Kemmy Business School, University of Limerick, Ireland

Background

Prophylaxis for RSV bronchiolitis is an important but costly means of reducing admissions to paediatric wards. The product literature, based on clinical trials, recommends that children born at less than 35 weeks gestation who are less than six months at the start of the RSV season should be given a course Palivizumab. The high cost of this monoclonal antibody has huge implications on local financial allocations. The data for its use however largely originates in the United Kingdom and United States of America and our literature search did not reveal studies performed on its cost-effectiveness in the Irish paediatric population.

Aims

The aims of the study were to determine;

1. the economic impact of RSV bronchiolitis in a 7 year cohort, and

2. whether broadening the inclusion criteria for prophylaxis would be cost-effective.

Method

A retrospective HIPE-data analysis provided information on in-patient cases of diagnosed bronchiolitis over a seven year period from October 1999 to January 2007. Only patients who had been delivered in the Mid-Western Regional Maternity unit were included, and gestational age reached was retrieved from labour ward records and added to the data set. Each patient was defined by variables including gestational age at delivery, age at diagnosis of bronchiolitis, and length of stay during RSV-admission. Those with negative RSV swabs or who were aged over one year at the beginning of vaccination season were excluded from the cohort, as were those with incomplete data. Information was compiled in a data file, cleaned, coded and analysed using SPSS version 14.0. Cost was calculated at per-bed-day rates on the premise that the babies admitted were subject to negligible cost of intervention.

Results

The final number in the cohort was 553. The total cost of RSV admissions during the period of the study was 2,469,901.44euro, and these patients occupied 2489.82 bed-days over the 7 years and 4 month period. The cost of vaccinating under the current guidelines was found to be greater than the cost of their in patient stay. The cost of extending the guidelines to a) all babies born at less than 35 weeks gestation and less than one year of age at the start of the RSV season or b) all babies born at less than 37 weeks gestation did not prove to be cost-effective.

Conclusion

The economic impact of RSV prophylaxis has not, to date, been a deciding factor in the recommendations of its use. However, if economic ‘net-loss’ is taken as the baseline zero, a reasonable case could be made for widening the inclusion criteria.