***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Occasional reports have suggested that infants with congenital heart disease may have an increased risk of severe illness from respiratory syncytial virus ( RSV ) infection . We prospect ively studied 699 infants hospitalized during the winters of 1976 through 1980 , when RSV was prevalent in the community ; 229 of these infants had proved RSV infections acquired either before admission or during hospitalization ; 27 had both congenital heart disease and RSV infection , and 46 had congenital heart disease without RSV infection . Infected infants with congenital heart disease had significantly more severe illness than those without congenital heart disease , as judged by the requirement for intensive care and assisted ventilation and by the mortality rate ( 37 per cent vs. 1.5 per cent , P less than 0.01 ) . The infection was acquired nosocomially by 21 per cent of infected infants ; the mortality rate from nosocomial infection was also higher in infants with congenital heart disease ( 44 per cent vs. 5 per cent , P less than 0.01 ) . Pulmonary hypertension was the one condition particularly associated with severe RSV illness . Eight of the 11 infants ( 73 per cent ) with congenital heart disease and pulmonary hypertension died during their RSV illness . The courses in infants with congenital heart disease with and without RSV infection were also compared . Their ages , types of cardiac lesions , and incidence of pulmonary hypertension were similar , but the infants with RSV infection had a higher mortality rate ( 37 per cent vs. 6.5 per cent , P less than 0.1 ) Objective . To determine the impact of respiratory syncytial virus ( RSV ) prophylaxis among preterm infants of ≤32 weeks gestation by comparing the severity of illness and cost of RSV‐related care during the two winter seasons before ( 1994 to 1995 , 1995 to 1996 ) with the two seasons after initiation of prophylaxis ( 1996 to 1997 , 1997 to 1998 ) . Methods . Preterm infants of ≤32 weeks gestation at risk for hospitalization with RSV infection were identified retrospectively from the infants hospitalized in our neonatal units . Infants were included if they ( 1 ) were born 6 months before or during four winter seasons ( 1994 to 1998 ) , ( 2 ) were discharged from the neonatal unit and ( 3 ) had remained in the university outpatient clinic system during at least the first winter of life . Preterm infants of ≤32 weeks gestation hospitalized with RSV were identified from our RSV data base ( which includes cost of hospitalization , duration of hospital stay , pediatric intensive care unit stay and intubation ) . Infants receiving prophylaxis were identified prospect ively . Results . The incidence of hospitalization with RSV was significantly lower among the cohort of infants born after initiation of prophylaxis : 8.7 % ( 17 of 195 ) vs. 22 % ( 35 of 159 ) , P = 0.00049 by two tailed Fisher 's exact test . Among the cohort of infants born after initiation of prophylaxis ( n = 195 ) , 100 infants received prophylaxis . The gestational and chronologic ages of the prophylaxis‐treated infants were significantly lower than those of the non‐prophylaxis‐treated infants ( n = 95 ) . The prophylaxis‐treated infants also were more likely to have bronchopulmonary dysplasia . Only 1 ( 1 % ) of the prophylaxis‐treated infants required hospitalization for RSV . Comparison of the cohort of infants born before initiation of prophylaxis to the cohort born after initiation of prophylaxis ( includes prophylaxis‐treated and non‐prophylaxis‐treated infants ) revealed a significant reduction in severity of illness and cost . The length of stay in the cohort born before initiation of prophylaxis was reduced 83.8 % : 373.6 days per 100 infants at risk vs. 60.5 ( P = 0.00055 ) . The length of stay in the pediatric intensive care unit was reduced 92.7 % : 218.2 days per 100 infants at risk vs. 15.9 ( P = 0.00029 ) . The duration of intubation was reduced 95.6 % : 187.4 days per 100 infants at risk vs. 8.2 ( P = 0.00024 ) . The dollars spent for RSV‐related care ( hospitalizations and prophylaxis ) per 100 infants at risk for RSV was reduced 65 % in the cohort of infants born after prophylaxis : $ 670 590 per 100 infants at risk vs. $ 234 596 ( P = 0.00056 ) . This reduction remained significant ( 64.9 % ) if the cost of ribavirin ( drug and administration fees ) was excluded from the cost of hospitalization . Conclusions . These data reveal that RSV prophylaxis significantly reduced the incidence of RSV hospitalizations and severity of illness as well as the cost of RSV‐related care among these infants BACKGROUND Respiratory syncytial virus immunoglobulin intravenous ( RSV-IGIV ) has been shown to reduce the risk of lower respiratory illness ( LRI ) hospitalization in preterm infants and infants with bronchopulmonary dysplasia ( BPD ) . The purpose of this analysis was to estimate the economic costs and benefits of prophylaxis with RSV-IGIV in these groups . METHODS The analysis was performed from a payer 's perspective and therefore included only costs and cost savings that would be realized by an insurer . Estimates of the direct costs of prophylaxis and the risk and cost of LRI hospitalization were based on data about preterm very low birth weight infants cared for at our medical center . Estimates of the reduction in risk of LRI hospitalization associated with RSV-IGIV were based on data from a r and omized trial ( the PREVENT Study ) . RESULTS The range of cost for a five-dose course of RSV-IGIV was estimated to be $ 3280 to $ 8800 for infants weighing 1.2 to 10.0 kg at the time of the initial dose . Risks of LRI hospitalization were estimated to be 12 , 17 and 28 % , respectively , for preterm infants without BPD , with mild BPD and with moderate to severe BPD . Estimates of duration and per diem cost of LRI hospitalizations were , respectively , 5 days and $ 971 . The estimated net cost of prophylaxis per infant ranged between $ 5415 for a 6-kg infant without BPD to $ 1689 for an infant with BPD and age < or =3 months . CONCLUSIONS The cost of RSV-IGIV typically exceeds the cost of hospitalizations prevented by several thous and dollars . Cost minus benefit is lower for infants with BPD and infants 3 months of age or younger OBJECTIVES To describe a method for measuring the direct and indirect costs to families of infants hospitalized with respiratory syncytial virus ( RSV ) . METHODS After pretesting and revising a question naire , a prospect i ve survey was conducted in multiple tertiary-care hospitals with pediatric intensive care units . Eligible patients were infants less than 12 months old who had not received RSV prophylaxis and were hospitalized with a confirmed RSV infection . All English- and Spanish-speaking caregivers of eligible subjects were asked to participate in a face-to-face , structured interview on the day of hospital discharge regarding hospitalization-related direct and indirect costs . Thirty days later , caregivers were re-interviewed by telephone about their RSV-related costs during the elapsed month . The survey was initiated in February 2000 and continued through April 2001 . RESULTS In addition to the infants ' parents , numerous adults visited 55 % of hospitalized infants . In 17 % of cases , nonparents missed work to visit the child . Volunteers watched siblings of 26 % of the infants . Relying only on closed-ended questions about parents ' costs during the hospitalization would have missed important information about child-care volunteers and types of expenses . Follow-up interviews revealed that RSV-related out-of-pocket expenses and missed work continued during the month following discharge . CONCLUSIONS Survey instruments should be pretested with potentially eligible subjects . Open-ended questions are needed , because all costs can not be anticipated . Respondents should be probed for details . This method revealed certain time and financial burdens during and after hospitalization that had not been previously reported in the literature Little is known about the risk of severe illness from respiratory syncytial virus infection in children with bronchopulmonary dysplasia . A prospect i ve study was done of the natural history of respiratory syncytial virus infection in 30 children less than 2 years of age with bronchopulmonary dysplasia who were in a home oxygen program .  Surveillance to identify children with acute respiratory symptoms was done by weekly telephone interview . Symptomatic children were examined , oxygen saturation was determined by oximetry , and nasopharyngeal lavage fluid was collected for virus cultures and rapid respiratory syncytial virus antigen tests . During the 4-month study period ( December to April ) , 27 children had one or more acute respiratory illnesses  , and respiratory syncytial virus developed in 16/27 ( 59 % ) . Passive smoking and greater than or equal to four members in the home increased the risk of symptomatic respiratory syncytial virus ( P less than .01 and P less than .03 , respectively ) . Of 16 children , 11 ( 69 % ) required hospitalization . Of the 11 hospitalized children with respiratory syncytial virus , nine were either still receiving oxygen at home or required oxygen therapy within the previous 3 months v none of five nonhospitalized children ( P less than .005 ) . Five of the hospitalized children were greater than 12 months of age and five had respiratory syncytial virus infection previously that had been confirmed by culture results . Hospitalizations were prolonged and complicated . Seven of 11 children were hospitalized for greater than 1 week ; four were admitted to the intensive care unit ; four were treated with ribavirin aerosol , and two needed mechanical ventilation . There were no deaths . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVES To quantify the cost and distribution of health care re sources consumed annually in management of Canadian children from birth to 4 years of age with respiratory syncytial virus ( RSV ) infection . STUDY DESIGN Estimates of direct medical expenditures ( in 1993 U.S. dollars ) were collected from a prospect i ve cohort study of hospitalized children with RSV and from national and provincial data bases . RESULTS The annual cost of RSV-associated illness was almost $ 18 million . The largest component of direct expenditures ( 62 % ) was for inpatient care for the estimated 0.7 % of all infected children ill enough to require admission . Physician fees comprised only 4 % of inpatient expenses . Expenditures for ambulatory patients accounted for 38 % of direct costs . CONCLUSIONS The greatest reductions in the economic cost of RSV infections will be found in interventions that reduce duration of or prevent hospital stay . Costs for management of RSV infection in children in the Canadian health care system are considerably less than charges reported in the United States OBJECTIVES To estimate how many infants in selected high-risk subgroups would require treatment with respiratory syncytial virus immune globulin ( RSV-IG ) to avoid 1 hospital admission and to determine whether this is economically justified . DESIGN Cost-benefit analysis . Data from 3 r and omized controlled trials of RSV-IG are used to estimate the number needed to treat to prevent 1 hospital admission for respiratory syncytial virus infection . The threshold number needed to treat is computed according to a formula incorporating costs and benefits of RSV-IG prophylaxis . Estimates of the willingness to pay were obtained from a sample of 39 health care providers ( 35 physicians and 4 nurses ) . MAIN OUTCOME MEASURES The number needed to treat to prevent 1 hospital admission for respiratory syncytial virus infection . The threshold number needed to treat that would balance costs with benefits . RESULTS More than 16 ( 95 % confidence interval , 12.5 - 23.8 ) infants would need to be treated with RSV-IG to avoid 1 hospital admission for respiratory syncytial virus infection , ranging from 63 for premature infants without chronic lung disease to 12 ( confidence interval , 6.3 - 100.0 ) for infants with bronchopulmonary dysplasia . A sensitivity analysis of the costs and values of hospital admission for respiratory syncytial virus infection and RSV-IG treatment result ed in a weak recommendation against the treatment of infants with bronchopulmonary dysplasia and strong recommendations that the costs and risks of RSV-IG treatment outweigh the benefits for the combined sample of infants and premature infants without lung disease . CONCLUSIONS The number-needed-to-treat procedures offer a method to assess evidence of treatment effects and decision rules for whether to accept treatment recommendations . Under plausible assumptions , treatment with RSV-IG is not recommended for infants without lung disease . Institutions can examine cost and benefit assumptions that best fit their own practice setting For 10 winters , 608 children five years old or younger who were hospitalized with respiratory syncytial virus ( RSV ) infection were prospect ively studied to evaluate the relation between their immune status and the severity of their 
    Output:
    
Studies comparing the 2 agents reported mixed results about their relative cost-effectiveness in different infant subgroups .