Managed Care - January 2009 - (Page CB-B2)

Impact of RSV: Implications for Managed Care Respiratory syncytial virus (RSV) disease is the leading cause of infant hospitalization, and premature infants are particularly at high risk. Timely RSV management strategies can help reduce costly RSV hospitalizations. Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections — particularly bronchiolitis — in infants and young children in the United States, and is the leading cause of hospitalization of infants younger than 1 year of age (Leader 2002, Shay 1999). Up to 126,000 infants are hospitalized each year because of severe RSV disease, 20 percent of whom are premature infants, and the number and rate of hospitalizations may be increasing (Leader 2002, Shay 1999). In addition, it is estimated that up to 400 children younger than 1 year of age die each year due to severe RSV infection (Shay 2001, Thompson 2003). RSV disease contracted in infancy may also be associated with respiratory ailments later in life, such as recurrent wheezing and physician-diagnosed asthma in childhood (Sigurs 2005, Stein 1999). The economic burden on the U.S. health care system is significant. Direct medical costs of RSV-associated hospital care for infants (emergency department visits and inpatient stays) over a 4-year period, 1997 to 2000, amounted to an estimated $3 billion, or an annual average cost of $750 million (Leader 2003a). Between 1997 and 2002, the RSV hospitalization rate among infants younger than 1 year of age increased by 25 percent, with the highest hospitalization rate being among infants during the first 3 months of life (45.3 per 1,000) (McLaurin 2005). Mean hospital charges for RSV increased by 39 percent between 1997 and 2002 and totalled more than $1.1 billion in 2002 (McLaurin 2005). Furthermore, RSV hospitalization of infants is associated with substantial time, out-of-pocket, and productivity losses for the affected families and, by extension, society in general (Leader 2003b). These data underscore the need for the early and careful identification, evaluation, and management of infants younger than 1 year of age — particularly premature infants — who may be at high risk of severe RSV disease. Why are premature infants at high risk? Acute infection of the lower respiratory tract, which manifests clinically as bronchiolitis or pneumonia, is the hallmark of severe RSV disease. RSV outbreaks generally occur during the annual RSV season of November through April, although the season can vary greatly throughout the country or during any 1 year, and even among close communities (AAP 2006, Mullins 2003, Panozzo 2007). Infection is easily transmitted, usually hand to hand or by contact with contaminated surfaces, such as kitchen and bathroom countertops, and even toys, clothing, and other objects (AAP 2006, Hall 1980). Spread in households and child-care centers is common, as is reinfection (AAP 2006, Hall 2001). Preterm infants (35 weeks or less gestational age [GA]); infants with congenital heart disease (CHD); and premature infants with chronic lung disease (CLD) are known populations at an increased Term risk of developing severe RSV disease (AAP 2006, Boyce 2000, Law 2004). Premature infants have an elevated risk of RSV susceptibility primarily because they have fewer disease-fighting anti36 weeks GA bodies — maternal antibody transfer to 3 years generally occurs during the third trimester or after 28 weeks (Yeung 1968). Also, their lungs are less mature than the lungs in full-term infants (Langston 1984). As shown in Figure 1, preterm infants have about half the lung volume of full-term infants, with a thicker airspace wall, which results in impaired gas exchange; alveoli, the distal, tiny grape- FIGURE 1 Lung development in infants up to full term Fetal development Preterm 8 weeks GA 16 weeks GA 24 to 35 weeks GA infants 32 to 35 weeks GA are within the same stage of lung development as infants 28 to 32 weeks GA GA= gestational age. Adapted from Moore 2003 2

Table of Contents Feed for the Digital Edition of Managed Care - January 2009

Managed Care - January 2009 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Health Care's Disruptive Innovations Q&A With Clayton Christensen 'Disruption' May Be Plans' Best Bet Avoid the PBM Rebate Trap HealthPartners Puts Diabetes on Notice Formulary Files Plan Watch Tomorrow's Medicine Ad Index Outlook Unmet Needs in the Management of Plaque Psoriasis Impact of RSV: Implications for Managed Care

Managed Care - January 2009

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