122: Effect of the Revised AAP Statement for Palivizumab Eligibility on Enrolment and Drug Cost in a Retrospective Provincial Cohort of Premature Infants
Bibliographic record
Abstract
Recommendations for palivizumab immunoprophylaxis in premature infants have changed in response to general improvements in outcomes of premature infants and changes in demographic and frequency of RSV-related hospitalization. In August 2014, AAP revised its policy statement limiting palivizumab prophylaxis in premature infants to those <29 weeks gestation. The effect of this change is uncertain but can be estimated on previous cohorts. To assess the impact of the revised eligibility criteria for palivizumab prophylaxis on the number of eligible premature infants and the cost of palivizumab used. The Manitoba RSV Immunoprophylaxis Program coordinates RSV immunoprophylaxis for the province of Manitoba. The Program receives notification of all births <35 weeks gestation. Premature infants ≤32 weeks gestation, and 33–35 weeks gestation at high risk for RSV-related hospitalization (based on risk scoring or residing in remote communities) are eligible for immunoprophylaxis. Anonymized data from the three seasons (2011–14) on the number of premature infants enrolled, amount of palivizumab received, and proportional cost of palivizumab was abstracted and reanalyzed applying <29 weeks gestation as cut-off for eligibility. For the three seasons, 672 premature infants (Table 1) were enrolled and received palivizumab. Total cost of palivizumab for this cohort was $2,877,096 (Canadian). Limiting eligibility to <29 weeks gestation reduced enrollment to 113 premature infants with cost of palivizumab of $467,684. Revision to eligibility criteria would have resulted in 559 fewer infants receiving palivizumab and a cost reduction of $2,409,412 over the past three seasons. The AAP revised policy statement limiting palivizumab eligibility to premature infants <29 weeks gestation will have a large impact reducing number of premature infants eligible and the cost of palivizumab utilized. In a provincial-based cohort, retrospective application of the new eligibility criteria would have resulted in 559 fewer eligible infants and a cost reduction of $2.4 million over the past three seasons.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.066 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".