Respiratory syncytial virus immune globulin: Decisions and costs

A decision analysis was used to evaluate the economic effectiveness of respiratory syncytial Virus immune globulin (RSVIG) prophylaxis on selected pediatric populations at risk for developing RSV bronchiolitis or all respiratory illness-related hospitalizations. We compared costs, outcomes, and cost-effectiveness of administering RSVIG to no treatment in different pediatric populations, including those at risk of developing RSV-bronchiolitis and those at risk of developing any respiratory illness-related hospitalization. We observed that if only infants at high risk of severe RSV infections received treatment with RSVIG, a calculated cost saving of about $27,000 per hospitalization prevented were realized. If the Food and Drug: Administration (FDA)-approved indications for RSVIG were followed, the cost to prevent one hospitalization due fo RSV bronchiolitis would be over $53,000. If the aim, however, was to prevent all respiratory ill ness-related hospitalizations for this broader population, a much lower cost ($4,000) to prevent one hospitalization would result. In this situation, cost neutrality was possible, with a therapy cost of $2,843 compared to the actual average therapy cost of $4,444, Sensitivity analysis showed that the model was relatively insensitive to all variables, with the exceptions of costs related to RSVIG and intensive care unit (ICU) admissions. We conclude that RSVIG resulted in cost savings if therapy were reserved for the infants who are at highest risk for developing severe RSV infections, RSVIG is not cost-effective for preventing RSV bronchiolitis when used according to the FDA-approved indications. Education that emphasizes frequent hand-washing, avoidance of passive smoking, and lessening exposure to sick children remains the least expensive prevention tool. (C) 2001 Wiley-Liss, Inc.