837 Learning from a case control audit on local cost efficacy of palivizumab at East Midlands Congenital Heart Centre

Aims 1. Evaluate the cost-effectiveness of palivizumab by comparing outcomes in cardiac patients who received palivizumab compared to those who did not 2. Improve the identification of cardiac patients eligible for palivizumab 3. Reduce postoperative length of stay in cardiac PICU due to complications from RSV infection 4. Prevent the postponement of cardiac surgery due to acute RSV infection 5. Improve the delivery of palivizumab immunisations to all eligible cardiac patients across the EMCH network Methods Eligible cardiac patients under 2 years old were identified from RSV clinic lists and pharmacy records. Data collected on palivizumab doses, bronchiolitis diagnosed and RSV swab status, length of stay on PICU. Data was collected from medical notes, pharmacy dispensing records, prescription charts, electronic prescribing software, iLab and ICE result reporting systeThe time period analyzed spanned from October 2019 to August 2020. Results 77 eligible patients were identified. 13 Leicester patients received palivizumab. 44 doses of palivizumab administered to n=13 costing £34,524.¹ Average cost of a full course of palivizumab was £4,569. None had RSV positive bronchiolitis among the 6/13 patients completed the full course (table 2). All 3 cases of RSV positive bronchiolitis occurred in patients who did not complete a full course of palivizumab (table 2). 2 RSV positive cases in the control arm (n=15); one had 2 week inpatient stay and another case of PDA ligation spent 25 inpatient days postoperatively. Overall estimated costs for the length of stay and Synagis were £37,515 in the palivizumab group and £29,744 in the control arm (table 1). Limited by lack of data from n=64 patients across the network district general hospitals, restricted sample size to n=13 immunized at East Midlands Congenital Heart Centre and limited the power of study.¹ Conclusion This study suggested that RSV-prophylaxis was cost beneficial. RSV-prophylaxis reduced length of stay due to RSV bronchiolitis; 2 days (palivizumab arm) vs. 39 (control group) (table 1). Of the 6 patients who completed a full 5-dose course of palivizumab, 0 contracted RSV positive bronchiolitis (table 2). Cardiac patients who did not complete a full course of palivizumab were at higher risk of contracting RSV bronchiolitis. Numbers were far too limited to reach statistical reliability and a second audit cycle was not run as RSV rates diminished due to the effect of COVID-19 lockdown and the previous seasonal pattern of RSV prevalence was not observed.² Earlier patient identification, closer monitoring & stewardship of palivizumab eligible cardiac patients needed across the regional network to facilitate better uptake, delivery & concordance of RSV prophylaxis regimen over the winter period. References Liao et al. British Congenital Cardiac Association Annual Conference poster. 2021. Agha R, Avner JR. Delayed seasonal RSV surge observed during the COVID-19 pandemic. Pediatrics 2021;148:e2021052089.