Unintended Consequences Following the 2014 American Academy of Pediatrics Policy Change for Palivizumab Prophylaxis among Infants Born at Less than 29 Weeks' Gestation.

Objective: The aim of this study is to compare outpatient respiratory syncytial virus (RSV) immunoprophylaxis (IP) use and relative RSV hospitalization (RSVH) rates for infants <29 weeks' gestational age (wGA) versus term infants before and after the 2014 American Academy of Pediatrics (AAP) policy change.
Study Design: Infants were identified in the MarketScan Commercial and Multi-State Medicaid databases. Outpatient RSV IP receipt and relative <29 wGA/term hospitalization risks in 2012 to 2014 and 2014 to 2016 were assessed using rate ratios and a difference-in-difference model.
Results: Outpatient RSV IP receipt by infants <29 wGA and aged <3 months in the Commercial and Medicaid populations and those aged 3 to <6 months in the Medicaid population declined after 2014. Relative RSVH risks for infants <29 wGA were numerically greater after 2014, with infants aged <3 months and Medicaid infants experiencing the greatest increases. Difference-in-difference results indicated a significantly increased relative risk of RSVH for infants <29 wGA versus term (both cohorts aged 0 to <6 months) in the Medicaid-insured population (1.68, p  = 0.0054). A nonsignificant increase of similar magnitude occurred in the commercially insured population (1.57, p  = 0.2867).
Conclusion: The 2014 policy change was associated with a decrease in RSV IP use and an increase in RSVH risk among otherwise healthy infants <29 wGA.
Competing Interests: M.G. received grant/research support from AstraZeneca/MedImmune and is a member of the AstraZeneca Speakers' Bureau. L.R.K. received grant and research support for clinical trials from AstraZeneca, Regeneron, Pfizer, and Sanofi Pasteur. He has also been a consultant to Pfizer. J.F. received grant/research support from AstraZeneca/MedImmune and is a member of the AstraZeneca and Sobi Speakers' Bureaus. L.B. and C.S.A. are employees of AstraZeneca. S.W.W. is a consultant to IBM Watson Health. A.M.K. is an employee of IBM Watson Health, which received funding from AstraZeneca to conduct this study.
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