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The potential impact of prophylaxis against bronchiolitis due to the respiratory syncytial virus in children with congenital cardiac malformations

Published online by Cambridge University Press:  03 May 2005

Oliver J. Rackham ,
Kentigern Thorburn  and
Steve J. Kerr
Oliver J. Rackham
Affiliation:
Paediatric Intensive Care Unit, Alder Hey Hospital, Royal Liverpool Children's Hospital, Liverpool, United Kingdom
Kentigern Thorburn
Affiliation:
Paediatric Intensive Care Unit, Alder Hey Hospital, Royal Liverpool Children's Hospital, Liverpool, United Kingdom
Steve J. Kerr
Affiliation:
Paediatric Intensive Care Unit, Alder Hey Hospital, Royal Liverpool Children's Hospital, Liverpool, United Kingdom
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Abstract

Aims: To determine the number of infants in the Mersey and North West regions with congenital cardiac disease for whom palivizumab may be appropriate, and to examine the potential impact of introducing prophylaxis with palivizumab on these patients and their economic management. Methods: We identified those infants deemed to be at high risk, matching the population recently studied by the Cardiac Synagis Group, from the database of the cardiology department of the hospital. The number of patients under the care of the paediatric cardiologists admitted to Alder Hey Hospital with respiratory syncytial viral bronchiolitis over the last three seasons was identified from hospital coding records, and the database of the cardiology department. Results: There are 131 patients at high risk each year. Of these, over the last three “bronchiolitis seasons”, 39 infants have been admitted to the hospital with bronchiolitis due to the respiratory syncytial virus. This represents a hospitalisation rate of 10 per cent, as was seen in the study of the Cardiac Synagis Group. Using a monthly dose of 15 milligrams per kilogram for five doses, the cost per patient is 2,650 pounds sterling for the season. To treat the 131 patients seen at Alder Hey, therefore, would cost 346,800 pounds each year. Applying the reductions in hospitalisation identified in the study by the Cardiac Synagis Group to our population would produce an expected reduction in patients hospitalised from 13 to 7 per year, reducing the total length of stay in our hospital wards from 169 to 76 days, and in the paediatric intensive care unit from 93 to 21 days. This amounts to a potential saving of 190,800 pounds per year. Reducing transfers to more distant paediatric intensive care units for referrals refused because of lack of beds could save an additional 50,000 pounds. Discussion: We estimate the net cost of introducing palivizumab for this population to be 106,000 pounds per year. There would, of course, be additional costs involved in setting up this service, as well as additional savings and benefits. This cost is comparable with other new biologic therapies now routinely used in the United Kingdom, such as etanercept for juvenile arthritis. There are, currently, no other obvious therapies that have the potential to reduce admissions to hospital and intensive care during the winter months, when beds are at their most scarce.

Keywords

Palivizumabpaediatric cardiologyinfection
Type
Original Article
Information
Cardiology in the Young , Volume 15 , Issue 3 , June 2005 , pp. 251 - 255
Copyright
© 2005 Cambridge University Press

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References

Simoes EA. Respiratory syncytial virus infection. Lancet 1999; 354: 847–852.Google Scholar
MacDonald NE, Hall CB, Suffin SC, Alexson C, Harris PJ, Manning JA. Respiratory syncytial viral infection in infants with congenital heart disease. N Engl J Med 1982; 307: 397–400.Google Scholar
Boyce TG, Mellen BG, Mitchel EF Jr, Wright PF, Griffin MR. Rates of hospitalization for respiratory syncytial virus infection among children in medicaid. J Pediatr 2000; 137: 865–870.Google Scholar
Feltes TF, Cabalka AK, Meissner HC, et al. Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease. J Pediatr 2003; 143: 532–540.Google Scholar
Clark SJ, Beresford MW, Subhedar NV, Shaw NJ. Respiratory syncytial virus infection in high risk infants and the potential impact of prophylaxis in a United Kingdom cohort. Arch Dis Child 2000; 83: 313–316.Google Scholar
Simpson S, Burls A. A systematic review of the effectiveness and cost-effectiveness of palivizumab (Synagis) in the prevention of respiratory syncytial virus (RSV) infection in infants at high risk of infection. A West Midlands Development and Evaluation Service Report. ISBN No. 0704423219. 2001. University of Birmingham.Google Scholar
Groothius JR, Simoes EAF, Levin MJ, et al. Prophylactic administration of respiratory syncytial virus immune globulin to high-risk infants and young children. N Engl J Med 1993; 329: 1524–1530.Google Scholar
Reduction of respiratory syncytial virus hospitalization among premature infants and infants with bronchopulmonary dysplasia using respiratory syncytial virus immune globulin prophylaxis. The PREVENT Study Group. Pediatrics 1997; 99: 93–99.
Simoes EA, Sondheimer HM, Top FH Jr, et al. Respiratory syncytial virus immune globulin for prophylaxis against respiratory syncytial virus disease in infants and children with congenital heart disease. The Cardiac Study Group. J Pediatr 1998; 133: 492–499.Google Scholar
Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. The IMpact-RSV Study Group. Pediatrics 1998; 102: 531–537.
Tulloh R, Marsh M, Blackburn M, et al. Recommendations for the use of palivizumab as prophylaxis against respiratory syncytial virus in infants with congenital cardiac disease. Cardiol Young 2003; 13: 420–423.Google Scholar
Netton A, Rees T, Harrison G. Paramedic and emergency ambulance services. Unit Costs of Health and Social Care 2002. Personal Social Services Research Unit, University of Kent, Canterbury, 2002.
Joint Formulary Committee. British National Formulary. British Medical Association and Royal Pharmaceutical Society of Great Britain, London, 2003.
Edge WE, Kanter RK, Weigle CG, Walsh RF. Reduction of morbidity in interhospital transport by specialized pediatric staff. Crit Care Med 1994; 22: 1186–1191.Google Scholar
Duppenthaler A, Ammann RA, Gorgievski-Hrisoho M, Pfammatter JP, Aebi C. Low incidence of respiratory syncytial virus hospitalisations in haemodynamically significant congenital heart disease. Arch Dis Child 2004; 89: 961–965.Google Scholar
Moore TJ, Weiss SR, Kaplan S, Blaisdell CJ. Reported adverse drug events in infants and children under 2 years of age. Pediatrics 2002; 110: e53.Google Scholar
Connor EM, McClain JB, Sorrentino M, Hirsch RL, Top FH. Safety surveillance in children treated with palivizumab. J Perinatol 2002; 52: 619 (Abstract P33).Google Scholar
Mohan AK, Braun MM, Ellenberg S, Hedje J, Cote TR. Deaths among children less than two years of age receiving palivizumab: an analysis of comorbidities. Pediatr Infect Dis J 2004; 23: 342–345.Google Scholar
Onuzo O. Re: Recommendation for the use of palivizumab as prophylaxis against respiratory syncytial virus in infants with congenital cardiac disease. Cardiol Young 2004; 14: 469.Google Scholar
Handforth J, Sharland M, Friedland JS. Prevention of respiratory syncytial virus infection in infants. BMJ 2004; 328: 1026–1027.Google Scholar
Yount LE, Mahle WT. Economic analysis of palivizumab in infants with congenital heart disease. Pediatrics 2004; 114: 1606–1611.Google Scholar
Royal College of Nursing – pay awards. 2005. http://www.rcn.org.uk/resources/pay/.
Golombek SG, Berning F, Lagamma EF. Compliance with prophylaxis for respiratory syncytial virus infection in a home setting. Pediatr Infect Dis J 2004; 23: 318–322.Google Scholar
Rationing and the NHS. Drugs and Therapeutics Bulletin 2003; 41: 55–56.