RSV is one of the most common causes of hospitalization and emergency room care among children in the first few years of life. RSV typically causes bronchiolitis but can also result in pharyngitis, laryngotracheobronchitis, pneumonia, and prolonged intubation. Studies of children hospitalized with RSV infection that include a substantial number of nonbronchiolitis RSV-related conditions also report higher median ages.
Determining true expenditures related to RSV infection requires diagnostic confirmation, a chart review, and an analysis of billing costs. One previous study used a U.S. database to estimate the nationwide hospital charges of RSV pneumonia; in 1998 dollars, the hospital charges for RSV pneumonia were $295,100,000 in 1993; $392,300,000 in 1994; and $295,800,000 in 1995. Individual records were not validated in that study, however, because all identifiers were removed; RSV bronchiolitis was not included in the analysis because that diagnosis was not assigned a separate International Classification of Diseases (9th revision) (ICD-9) code until 1996.
A study at a U.S. tertiary-care center, published in 2001, showed a comparable average cost of $4,338 per patient for fiscal year 1997 for patients with acute RSV bronchiolitis, similar to our mean cost of $5,037 for patients admitted to the ward only. Another study that estimated the economic burden of RSV-associated bronchiolitis hospitalizations yielded similar data. Studies from other countries have tended to yield lower figures.
Our intent was to measure the direct costs of hospitalization attributable to RSV at a single, tertiary-care facility. In our analysis, we did not calculate indirect costs, such as those related to secondary cases, and we did not include physician charges or the costs of outpatient follow-up care. An earlier study that had used indirect costs had been criticized for inflating the potential cost savings of products designed to prevent RSV infection. Our information thus provides a dataset of direct costs upon which to base future cost-benefit analyses. generic cialis 20mg
RSV immune globulin and palivizumab have proved effective as prophylactic therapy for RSV illness in high-risk children. Although most of the patients admitted to our ward service were not in a group previously identified to be at high risk for RSV infection, nine in 12 (75%) of those children who ultimately received ventilation and four in 13 (31%) of those children admitted to the PICU were in such a group. Thus, many of the children at high risk for RSV infection require intensive care or ventilation, at a significant cost. Approximately 55% of these cases of RSV might be prevented if prophylaxis were used in a timely manner in eligible children. Had all eligible children received prophylaxis and had these preventive measures been 55% effective, the estimated cost savings during the season we studied at our institution could have been more than $250,000.
Potential cost savings at the hospital level, of course, must be balanced against the cost of prescribing palivizumab for about 17 healthy individuals to prevent a single hospitalization. For the season we studied, prophylactic measures to prevent the high-risk eligible cases could have cost as much as $970,000, based on one vial of palivizumab per dose (about $950 per vial in 1998 at our institution) and five doses per season. More important than cost, however, is the 50 patient-days of hospital-ization that might have been avoided during the season studied. Our estimated cost-benefit ratio of 3.88 ($970,000/$250,000) can be compared with that of Shireman and Braman (6.67) using data from the 1999-2000 season in Kansas.
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Acknowledgments. We thank the Medical Records and Business Development Office (particularly Mark A. Dembski) of Children’s Memorial Medical Center for assistance. This study was supported, in part, by MedImmune, Inc., and was presented in preliminary form at the Annual Meeting of the Society for Pediatric Research in Boston, May 12, 2000.