Open Access Research article

Association of RSV-related hospitalization and non-compliance with Palivizumab among commercially insured infants: a retrospective claims analysis

Dan L Stewart12*, Kellie J Ryan3, Jerry G Seare4, Brett Pinsky4, Laura Becker4 and Michael Frogel5

Author Affiliations

1 Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY 40202, USA

2 Kosair Children’s Hospital, Louisville, KY, USA

3 Health Outcomes and Pharmacoeconomics, MedImmune, Gaithersburg, MD, USA

4 Optum, Eden Prairie, MN, USA

5 Division of General Pediatrics, Steven and Alexandra Cohen Children’s Medical Center, New Hyde Park, NY, USA

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BMC Infectious Diseases 2013, 13:334  doi:10.1186/1471-2334-13-334

Published: 19 July 2013



Palivizumab has been shown to decrease the incidence of hospitalization due to respiratory syncytial virus (RSV) in infants at risk of severe RSV disease. We examined the association between compliance with palivizumab dosing throughout the RSV season and risk of RSV-related hospitalization in clinical practice.


Subjects who were born and discharged from the hospital before the RSV season and received ≥1 palivizumab dose during their first RSV season were identified from a large US commercial health insurance database between 01/01/03 and 12/31/09. Subjects were deemed compliant if they received ≥5 palivizumab doses without gaps (>35 days) and their first dose was received by November 30. RSV-related hospitalizations were identified using ICD-9-CM diagnosis codes and examined over 2 observation periods: post-index dose and RSV season. A Cox proportional hazard model was used to evaluate the association between non-compliance and RSV-related hospitalization.


Of the 5,003 subjects who received palivizumab, 62% were deemed non-compliant. Non-compliant subjects had significantly higher unadjusted rates of RSV-related hospitalizations compared to compliant subjects during both observation periods (post-index: 6.1 vs. 2.8 per 100 infant seasons, p < 0.001; RSV season: 5.9% vs. 2.3%; p < 0.001). In multivariate analyses, non-compliance was significantly associated with higher risk of RSV-related hospitalization (HR = 2.01; p < 0.001). Of the 225 RSV-related hospitalizations observed during the RSV season, 61 (27%) occurred before the first dose of palivizumab.


Subjects who did not receive monthly dosing of palivizumab throughout the RSV season had significantly higher rates of RSV-related hospitalizations. The RSV-related hospitalizations prior to the first dose of palivizumab suggest some dosing was started too late.

Respiratory syncytial viruses; Palivizumab; Patient compliance; Hospitalization; Infants