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Study 2 Citation: Linda M Schrand, Jane M Elliott, Mary B Ross, Edward F Bell, and Alan H Mutnick A
Cost–Benefit Analysis of RSV Prophylaxis in High-Risk Infants. Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, USA. linda-schrand@uiowa.edu |
Click on the link at left to go to your desired page: Introduction Page 2 Page 3 Study 1 Study 2 Study 3 Study 4 Implications for Social Workers Conclusion Post-Test
Abstract:
The authors set out to determine the cost and benefit of RSV-IG along with
palivizumab prophylactically in infants at high-risk for becoming infected
with respiratory syncytial virus (RSV).
Their methods were to conduct a nonrandomized, retrospective, controlled study to determine if data collected from patients that had received either RSV-IG or palivizumab therapy during the 1998-1999 RSV season would have been effective during the 1994-1995 RSV season with patients seen at the time (had either agent been available at that time). Medical records reviews were conducted to determine costs in both groups for administering the drug therapy and any hospitalizations that occurred. Average costs were determined for both groups using a decision analysis, and a cost benefit analysis was performed to look at potential return on investment from the use of these drugs. And finally, final data was analyzed to determine its accuracy.
Key words:
Palivizumab, respiratory syncytial virus infections, RSV-IG , bronchiolitis, pneumonia, gestation, immunoprophylaxis.
The most common cause of serious respiratory tract infections in children is respiratory syncytial virus (RSV). Back in 1990, before the advent of prophylactic drug therapy, nearly 50% of hospitalizations due to bronchiolitis, and 25% of hospitalizations due to pneumonia were caused by RSV. RSV affects nearly children the time they are two years old, and in the U.S. has resulted in more than 90,000 pediatric hospitalizations and some 4,500 deaths.
There are several known risk factors for RSV, primarily those with a compromised immune system due to premature birth (<32 weeks gestation), chronic lung disease (CLD) and congenital heart disease. Vaccination development efforts have so far been in vain, but one intervention in particular has shown to be particularly effective.
Passive immunoprophylaxis is the key to the first agent approved by the FDA for use in RSV, respiratory syncytial virus immune globulin (RSV-IG, RespiGam). The second drug approved for use in RSV was palivizumab (Synagis), a monoclonal antibody produced by recombinant DNA technology. The American Academy of Pediatrics has recommended the use of these prophylactic agents with high-risk children, even though there is a significant cost involved for these therapies.
The researchers in this study wanted to conduct a cost-benefit analysis using palivizumab prophylactically against RSV. Through the use of a nonrandomized, retrospective study design, participants were chosen from two different RSV seasons. Obvious limitations to this design can be seen, namely in the differences between strains existent from the two different seasons, and the basic limitations of a retrospective study design. Additionally, outpatient costs for RSV infections are not included, RSV-related admissions may have been missed, and future RSV-related complications (e.g., asthma) were not factored in.
Given that, the authors concluded that palivizumab was a cost-effective therapy in the treatment of RSV, and that quality of life was impacted significantly through reduced related hospital admissions.
Results:
Statistically speaking, the palivizumab group achieved a better outcome at a lower cost.
| palivizumab group | non-palivizumab group | |
| hospital admission rate | 1.60% | 25% |
| average cost for treatment | $3,733 | $4,258 |
The benefit–cost ratio is 1.15:1 ($3985:3461). The benefits, therefore, exceed the costs associated with the prophylaxis program. The prophylaxis program saved healthcare dollars by preventing RSV-related hospitalizations.
Summary of Study 2:
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Although this study is somewhat biased due to several independent factors: outpatient costs of RSV infections not being included; medical record review possibly having missed RSV-related admissions; patients being taken from only one institution; patient records being compared similarly from two different seasons; and not including future economic implications of an RSV-related infection (such as the propensity to develop asthma following such an infection), Schrand et al. found palivizumab to be profoundly effective, easy to administer and cost-effective. The most marked results of this study demonstrated that, when used according to consistent criteria, RSV prophylaxis has benefits that exceed its associated costs. The benefit per patient realized average savings to the institution of 23.4% over the chance of hospitalization, or a total of $3985 per patient. |