Managed Care - January 2009 - (Page CB-B4)

TABLE Risk factors associated with an increased risk of RSV hospitalization Risk factor Multiple births Low birthweight (<2500 g)14,16,17,18, 22 Crowded living conditions3,11,5,19 Family history of asthma3,11,20,21 Young chronological age (<12 wks)1,2,3,22 Exposure to environmental smoke1,2,11,12,13,21,23 *School-age siblings1,2,3 *Day care attendance2,4,5,6 *Exposure to environmental air pollutants7 *Severe neuromuscular disease8,9 *Congenital abnormalities of the airways8 14,15 Odds ratio 2.414, 7.015, 2.416, 6.517, 2.218, 13.914, 7.70 (<1.5 kg) or 2.43 (1.5–2.49 kg)22 2.411, 1.93, 4.75, 1.9319 2.111, 1.93,2.220, 1.7421 1.631, 4.92, 3.953, 8.46 (<3 mos) or 4.15 (3–5 mos)22 1.631, 3.211, 1.872, 1.2821, 5.0623 1.61, 2.762, 2.83 1.64, 2.25, 2.06, 12.22 No quantitative analysis published (excluding tobacco smoking studies) 4.94 PICU admissions10 No quantitative analysis published * AAP identified risk factors. PICU=pediatric intensive care unit. Sources: 1Carbonell-Estrany 2001, 2Law 2004, 3Figueras-Aloy 2004, 4Celedon 1999, 5Holberg 1993, 6Marbury 1997, 7AAP 2006, 8Arnold 1999, 9Panitch 2004, 10 Wilkesmann 2007, 11McConnochie 1986, 12DHHS 2006, 13Hall 1984, 14Holman 2003, 15Simoes 1993, 16Lanari 2002, 17Leader 2003a, 18Cilla 2006, 19Anderson 1988, 20 Wang 1998, 21Carroll 2007, 22Rossi 2007, 23Von Linstow 2008 health care costs for infants 33 to 36 weeks GA with no history of RSV hospitalization, or even with full-term infants who have a history of RSV hospitalization (Figure 4). In addition, as shown in Figure 5, the RSV hospitalization rate for preterm infants is nearly double the rate for low-risk, fullterm infants. Also, infants born 33 to 35 weeks GA have double the hospital length of stay, double the length of stay in the neonatal intensive care unit (NICU), and more than triple the intubation rate of full-term infants (Figure 6). Managing RSV Prematurity is associated with a greater use of hospital resources and poorer clinical outcomes during RSV hospitalization (Boyce 2000, Horn 2003, Law 2002). A comprehen- FIGURE 4 Infants with a history of RSV hospitalization are associated with increased health care costs In the first year of life, infants 33 to 36 weeks GA with a history of RSV hospitalization cost: – Nearly 5 times as much as infants 33 to 36 weeks GA with no history of RSV hospitalization – Nearly 4 times as much as full-term infants with a history of RSV hospitalization Average total cost per infant during the first year of life (excluding the birth hospitalization)* 100 Average payment ($) $82,822 No history of RSV hospitalization History of RSV hospitalization 80 60 40 20 0 <33 weeks $37,168 $26,187 $7,827 $2,143 $10,298 33–36 weeks Full term * The results shown are based on a study of 50,184 commercially insured infants born in calendar year 2004 who survived their first year of life. The results reflect the mix of risk characteristics underlying the study population. Care should be used when generalizing the results to other infant populations. The costs associated with the first year of life are influenced by factors which could result in material differences in observed results, including the delivery system and overall cohort morbidity (i.e., presence of other significant medical conditions). GA=gestational age. Source: Milliman Report, Feb. 19, 2007 4

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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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