Respiratory syncytial virus (RSV) is the most common cause of hospitalization for bronchiolitis and pneumonia (infections of the lower respiratory tract) in infants and children under one year of age during the winter. Earlier studies had indicated that 0.1% to 1% of all RSV infections resulted in hospitalization, with higher rates seen in children born before 32 weeks of gestation and in children with bronchopulmonary dysplasia.

In 2001, Shay and associates estimated that there were between 73,400 and 126,300 hospitalizations per year for RSV bronchiolitis and/or pneumonia in the U.S. in children younger than one year of age from 1994 to 1996, with substantial increases noted since 1980. A case-fatality rate of 2.5% has been reported for children hospitalized with RSV infection younger than one year of age. Most of the deaths occurred in children with chronic underlying diseases (e.g., congenital heart disease, sickle cell disease, cystic fibrosis), although recent mortality rates appear to be decreasing.

Palivizumab (Synagis®, Medlmmune) can effectively prevent hospitalizations caused by RSV infection in infants; it is commonly used only for the following patients:
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  • children at high risk for severe disease (i.e., those younger than two years of age with chronic lung disease who have required medical therapy in the previous six months)
  • infants younger than one year of age, born at or less than 28 weeks of gestation
  • infants younger than six months of age, born between 29 and 32 weeks of gestation
  • infants younger than six months of age, born between 33 and 35 weeks of gestation with additional risk factors for RSV infection

Despite the generally accepted safety and efficacy of palivizumab, the decision to provide prophylaxis for RSV infection is influenced by its cost-benefit ratio. The objective of our study was to evaluate the actual charges and costs associated with hospitalizations caused by infection with RSV at a tertiary-care medical center. From the results, we hope to accurately determine the true expenditures of hospital-based RSV care so that future cost-benefit analysis of prophylaxis can be even more comprehensive and rigorous.