RSV therapy not cost-effective for infants

Treatment with Synagis (palivizumab), a type of antibody therapy, is not a cost effective way of preventing infection with respiratory syncytial virus (RSV) in high-risk infants, according to two new reports published in the medical journal Pediatrics.

The American Academy of Pediatrics recommends Synagis for infants and young children born prematurely with at least two other risk factors and for those with congenital heart disease.

Drs. Laura E. Young and William T. Mahle, at Emory University School of Medicine in Atlanta, conducted a cost analysis to determine if the protection offered by the drug was worth the cost.

The total cost of Synagis during one RSV season was estimated to be $6,160 per child. Considering the cost of Synagis versus hospitalization, the authors estimate a net loss of more than $20 million per 5,000 patients.

"The cost of administering the (Synagis) regimen to prevent one day of hospitalization was $4,600 - nearly three times the cost of one day in the hospital," they note.

"Given the large number of congenital heart disease patients who might be considered candidates for (anti-RSV therapy) routine use of Synagis in young children with... congenital heart disease needs to be evaluated further," Young and William advise.

Dr. Steven Wegner and colleagues at the University of North Carolina in Chapel Hill conducted a study of patients born prematurely who were enrolled in the North Carolina Medicaid program. They analyzed costs during the 2002 to 2003 RSV season for 185 infants administered Synagis and 182 who were not.

During that season, 5 patients in the Synagis group and 12 in the comparison group were hospitalized - not much of a difference from a statistical standpoint. There were no deaths in either group.

Despite no real differences in outcome, the seasonal costs per person were much higher in the Synagis group: $5,117 versus $371 in the comparison group.

Wegner's group points out that in light of ballooning Medicaid costs, many states have resorted to cutting enrollment and eliminating services.

"When Medicaid programs are faced with decisions concerning cutting enrollment versus reducing drug use that is not cost-effective, we feel certain that the choice is obvious," they note.

SOURCE: Pediatrics, December 2004.