612 - Fairly Allocating RSV Immunoprophylaxis

Poster Number: 612
Publication Number: 612.306

Jennifer Kusma, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Seema K. Shah, Lurie Children’s Hospital, Chicago, IL, United States; Govind Persad, University of Denver, Denver, CO, United States

Background: Nearly all infants will contract Respiratory Syncytial Virus (RSV) within the first two years of life. RSV infection causes significant infant morbidity and mortality. Currently, the only approved immunoprophylaxis (IP) is palivizumab, a monoclonal antibody therapy. Despite RSV being a common childhood illness, the health care system routinely fails to fairly allocate this IP to infants likely to benefit.

Objective: To apply ethical principles to the fair allocation of RSV IP and develop a framework to guide policy development.

Design/Methods: We first identify relevant, principled frameworks for fair allocation of scarce interventions. Next, we identify which ethical principles are relevant for the allocation of RSV IP to develop a fair allocation framework for this intervention. After comparing this framework to existing policies, we conclude with recommendations for stakeholders (e.g., payors and pediatricians) to improve fairness in allocation of RSV prophylaxis and reduce related health disparities.

Results: Three ethical principles―maximum benefit, equal concern, and mitigation of health inequities—have been proposed for fair allocation of scarce resources. Applying these principles to RSV IP, benefit is not maximized by existing criteria that assume RSV occurs primarily during the Fall-Winter. When RSV season shifts to the summer months, as in the COVID pandemic, at-risk children may be denied access. Similarly, restrictive insurance policies, such as prior authorizations for all RSV IP, fail to maximize benefit. Second, existing guidelines do not provide equal concern for all children that are likely to benefit from IP. For example, infants in rural areas may face delays in receiving appropriate care, and could therefore benefit from RSV IP in a cost-effective manner. Finally, RSV IP has the potential to mitigate health inequities. RSV infection disproportionately affects children from historically disadvantaged minorities, with higher rates of hospitalization due to RSV seen among Black and Hispanic infants—who are also more likely to have received partial RSV IP. Furthermore, because rates of preterm birth are higher for Black and Hispanic infants, expanding eligibility to more preterm infants would also expand availability of prophylaxis to these groups, and thereby mitigate health inequities.Conclusion(s): Given the high cost and scarcity, creating a system that operationalizes ethical principles for fair allocation of RSV IP can improve outcomes and equity in treatment.