Subtracting 96 from 118, we derive 22 fewer hospitalizations for RSV in the Palivizumab Era (or an average of 7 fewer hospitalizations per year) as a result of the AAP policy expansion of palivizumab prophylaxis for HS-CHD patients. that, since the recommendation of palivizumab for children with HS-CHD in 2003, the impact on RSV hospitalizations in California among HS-CHD patients has been limited. Considering the high cost of palivizumab administration, the cost-benefit of RSV prophylaxis with palivizumab warrants further investigation. congenital heart disease;HS-CHDhemodynamically significant CHD Open in a separate window Fig.?2 Average length of stay (days) for all patients? 2?years of age (filled squaresopen circles /em ), 2000C2006 There were 36 deaths Pefloxacin mesylate among the RSV hospitalizations in 2000C2006. The in-hospital mortality rate was 0.07%, or 1 death per 1478 hospitalizations. The in-hospital mortality rate decreased from 0.09% in 2000C2002 to 0.06% in 2004C2006. There were five deaths among HS-CHD patients in California, of which four occurred prior to 2003 and one after Pefloxacin mesylate 2003. Impact of Palivizumab Prophylaxis We calculated that 0.56% of all RSV hospitalizations in 2000C2002 were HS-CHD patients, whereas 0.46% of all RSV hospitalizations in 2004C2006 were HS-CHD patients. If there had been no policy revision in 2003 to expand palivizumab use, the proportion of RSV hospitalizations with HS-CHD in 2004C2006 would have been 0.56% (the same as the proportion in 2000C2002). Therefore, there would have been a total of 118 hospitalizations of HS-CHD patients in 2004C2006 (0.56% of 20,881 total RSV hospitalizations in Pefloxacin mesylate California in 2004C2006). In 2004C2006, there were 96 observed RSV hospitalizations of HS-CHD patients. Subtracting 96 from 118, we derive 22 fewer hospitalizations for RSV in the Palivizumab Era (or an average of 7 fewer hospitalizations per year) as a result of the AAP policy expansion of Rabbit polyclonal to Synaptotagmin.SYT2 May have a regulatory role in the membrane interactions during trafficking of synaptic vesicles at the active zone of the synapse. palivizumab prophylaxis for HS-CHD patients. The reduction of 22 RSV hospitalizations for HS-CHD patients in 2004C2006 was equivalent to a total of 227 hospital days, that is, a decrease of 76 hospital days per year. Sensitivity Analysis In a sensitivity analysis, the 15.3% hospitalizations with incomplete age information were included in the analysis, assuming that all of these hospitalizations were among patients? 2?years of age. The overall hospitalization rate showed a trend of decrease similar to that shown in Fig.?1: from 9.85 hospitalizations per 1000 in 2002 to 6.95 hospitalizations in 2006. In calculating the number of RSV hospitalizations among HS-CHD patients, the reduction in RSV hospitalizations was 21 from the Prepalivizumab Era (2000C2002) to the Palivizumab Era (2004C2006), or an average of 7 fewer hospitalizations per year since 2003. Six hospitals in California participated in the palivizumab clinical trial and recruited HS-CHD patients for palivizumab use in the Prepalivizumab Era . The RSV hospitalizations in these hospitals in 2000C2006 accounted for 9.9% of all RSV hospitalizations. Of HS-CHD patients hospitalized for RSV, 32.2% were admitted to these six hospitals in the Prepalivizumab Era, which was not significantly different from the 33.3% in the Palivizumab Era ( em p /em ?=?0.83). When these six hospitals were excluded from analysis, it was calculated that the total reduction in HS-CHD hospitalizations was 20 hospitalizations from the Prepalivizumab Era to the Palivizumab Era. Cost of RSV Hospitalization The average hospital charge among HS-CHD patients was $70,365, and that per RSV hospitalization was $40,812. Therefore, the total cost saved in the Palivizumab Era was $897,864, from 22 hospitalizations avoided, or a savings of $299,288 in California per year. Discussion In the pivotal clinical trial that led to FDA approval of palivizumab use in HS-CHD patients and the AAP policy revision statement in 2003, a reduction in hospitalization rate of 45% in the palivizumab group, compared with the placebo group, was reported . In the current study, using population-level hospitalization data from California, we found that the reduction in RSV hospitalization rate for HS-CHD patients was? 20%, or an equivalent of seven fewer RSV hospitalizations per year for HS-CHD patients. The overall incidence of RSV hospitalization decreased during the study period 2000C2006 (Fig.?1). The steep decline in RSV incidence after 2003, which temporally correlated with the release of the AAP statement, suggests an effect of palivizumab prophylaxis on overall RSV hospitalizations. Another possible explanation for the decrease in overall RSV hospitalizations during the study period is a change in clinical practice, that those not-so-sick patients were not as likely hospitalized in the later era. We were not.
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