Non-compliance increased risk of RSV-hospitalization among Medicaid population

BOSTON — Non-compliance with palivizumab dosing was common among the Medicaid population, which significantly increased the risk of respiratory syncytial virus hospitalization, according to findings presented here during the 2012 Pediatric Academic Societies Annual Meeting.

Palivizumab (Synagis, MedImmune) is administered monthly prior to and throughout the RSV season to reduce the incidence of RSV hospitalization in premature infants, as well as infants with chronic lung disease of prematurity and hemodynamically significant congenital heart disease.

To determine the impact of non-compliance with palivizumab dosing and risk of RSV-hospitalization in a Medicaid-insured population, Leonard R. Krilov, MD, and colleagues, conducted a retrospective study using Medicaid claims data from 12 states.

Inclusion criteria for the study consisted of premature infants — aged 34 weeks’ or less gestational age — as well as infants with chronic lung disease of prematurity and/or congenital heart disease, who were discharged between May 1 and Sept. 30 and received one or more doses of palivizumab during their first RSV season.

Palivizumab compliance was assessed throughout six RSV seasons (2003-2009) and defined as a first dose by Nov. 30, five or more greater consecutive doses during the RSV season with no more than 35 days between doses. The percent of RSV hospitalization during the season was calculated for non-compliant and compliant cohorts. A logistic regression of RSV hospitalization was also performed, adjusting for non-compliance, birthweight, gestational age, comorbidities, and varied demographic and clinical characteristics.

According to the study, 8,443 high-risk infants received at least one dose of palivizumab. Approximately 67% of all infants were observed to be non-compliant; the percentage of RSV hospitalization was significantly higher among non-compliant vs. compliant infants (12.0% vs. 7.4%, P<.001).

Among all RSV-hospitalizations (n = 1,368), 37% occurred prior to the first dose. In the logistic regression model, non-compliant compared to compliant infants had a 1.33 (95% CI= 1.18, 1.49) increased odds of RSV hospitalization.

“This study demonstrates that when palivizumab is administered monthly starting before the season and monthly throughout the season, you achieve the best outcome and a lower hospitalization rate,” study co-author Parthiv J. Mahadevia, MD, MPH, told Infectious Diseases in Children. “When patients are non-compliant with this regimen, they have a significantly higher risk of RSV hospitalizations.” — Robert Stott

For more information:

Krilov LR. Abstract #1516.286. Presented at: 2012 PAS Annual Meeting; April 28-May 1, 2012; Boston.

Disclosure: Dr. Krivlov reported no relevant financial disclosures. Dr. Mahadevia is an employee of MedImmune.