Impact of hospitalizations for bronchiolitis in preterm infants on long-term health care costs in Italy: a retrospective case-control study

Abstract

PurposeBronchiolitis is an acute inflammatory injury of the bronchioles, and is the most frequent cause of hospitalization for lower respiratory tract infections in preterm infants. This was a retrospective, observational, case-control study conducted in Italy, based on administrative database analysis. The aim of this study was to evaluate differences in health care costs of preterm infants with and without early hospitalization for bronchiolitis.Patients and methodsPreterm infants born in the period between January 1, 2009 and December 31, 2010 and hospitalized for bronchiolitis in the first year of life were selected from the ARNO Observatory database and observed for the first 4 years of life. These preterm infants were compared (paired 1–3) with preterm infants who were not hospitalized for bronchiolitis in the first year of life and with similar characteristics. Only direct health care costs reimbursed by the Italian National Health Service were considered for this study (drugs, hospitalizations, and diagnostic/therapeutic procedures).ResultsOf 40,823 newborns in the accrual period, 863 were preterm with no evidence of prophylaxis, and 22 preterm infants were hospitalized for bronchiolitis (cases) and paired with 62 controls. Overall, cases had 74% higher average cost per infant in the first 4 years of life than controls (18,624€ versus 10,189€, respectively). The major cost drivers were hospitalizations, accounting for >90% in both the populations. The increase in total yearly health care cost between cases and controls remained substantial even in the fourth year of life for all cost items. A relevant increase in hospitalizations and drug consumption linked to respiratory tract diseases was noted in infants hospitalized for bronchiolitis during the entire follow-up period.ConclusionPreterm infants hospitalized for bronchiolitis in the first year of life were associated with increased resource consumption and costs throughout the entire period of observation; even in the fourth year, the difference versus paired controls was relevant.

Rhinovirus bronchiolitis, maternal asthma, and the development of asthma and lung function impairments

“…As this group of children is easily identifiable, if virus diagnostics are performed, they could be specifically targeted for interventions. This may partially reduce future health care costs that have been reported to be 83% higher in preterm infants admitted to hospital with bronchiolitis over their first 4 years of life in one recent study 35 …”

Healthcare resource utilization and costs in the 12 months following hospitalization for respiratory syncytial virus or unspecified bronchiolitis among infants

“…A study of 434 moderately pre-term infants in Spain found that wheezing was more common through the first 6 years of life among children with an infant inpatient admission for RSV, and that these children also had more outpatient visits, ED visits, and increased use of asthma medications than moderately preterm infants without an inpatient RSV admission 14 . More recently, an Italian matched cohort study reported that preterm (<37 wGA) infants with an inpatient admission for RSV-LRTI/UB (n ¼ 22) had 83% higher healthcare costs over their first 4 years of life, and that 18.2% of the RSV-LRTI/UB infants were re-hospitalized for related respiratory conditions between ages 2-4 compared with 1.6% of comparator infants (n ¼ 62) 17 .…”

“…In addition, RSVH has been associated with increased odds of subsequent wheezing, respiratory-related hospitalizations, and higher downstream healthcare resource utilization (HRU) and costs [14][15][16] . This increased healthcare burden may continue for several years and is not just restricted to severely premature (<29 wGA) infants 17 . Using US data from the MarketScan Multi-State Medicaid database covering births in 2003-2005, Shi et al 16 demonstrated that the burden following RSV-LRTI or unspecified bronchiolitis (UB) was highest for infants born at 33 wGA and that infants born at 34-36 wGA had higher HRU and costs in the year following these infections than term (!37 wGA) infants.…”

Indications to respiratory syncytial virus immunoprophylaxis in the 29–32 wGA group: is there still room for debating?

“…RSV disease represents also a risk factor for development of wheezing and asthma, reduced lung function, and irreversible airway obstruction [ 2 ]. Moreover, hospitalizations, Emergency Room and outpatient visits for community-acquired RSV disease are associated with significant resources consumption and increased healthcare costs, as demonstrated by a recently published Italian study [ 3 ].…”