An In-Home Synagis Program for RSV Prevention in High-Risk Infants

Abstract

OBJECTIVES: To evaluate and describe outcomes associated with a novel in-home administration program of respiratory syncytial virus (RSV) prophylaxis with palivizumab; to analyze health resource utilization and cost outcomes; and to assess parental satisfaction with in-home administration of prophylaxis for high-risk children. DESIGN: Descriptive program evaluation. SETTING: A national in-home RSV prophylaxis program for high-risk infants and children. PARTICIPANTS: 396 infants and children at risk for serious RSV infection. MAIN OUTCOME MEASURES: Incidence of RSV-related hospitalizations and emergency department (ED) visits, adverse events, program and hospitalization costs, compliance, and satisfaction. RESULTS: Compared with published reports of office, outpatient, or clinic based RSV prophylaxis with palivizumab, in-home prophylaxis demonstrated low incidence of total hospitalizations (11.4% versus 14.4%) and RSV-related hospitalizations (2.3% versus 4.8%). Less than 10% of patients required an ED visit and only 1% of those were related to RSV illness. Only one of the hospitalized infants required ICU admission. One-fourth of the patients experienced fever or ear infection; 43.2% developed cold symptoms. In-home palivizumab prophylaxis has the potential for saving $214 per patient over drug administration and hospitalization costs. Parental satisfaction with the in-home program was 98.6%, leading to high compliance; less than 2% of patients discontinued the program due to noncompliance. CONCLUSIONS: In-home administration of palivizumab RSV prophylaxis can provide favorable outcomes, high parent satisfaction, and potential cost savings. Incidence of RSV-related hospitalizations among patients given prophylaxis at home was substantially lower than has been reported with outpatient or clinic-based prophylaxis. Compliance was excellent due to ease of administration of intramuscular palivizumab, convenience for families with multiple or premature infants or infants requiring cumbersome medical devices, and parents' desire to minimize the risk of exposure to RSV and other communicable diseases in clinics. Improved clinical outcomes observed with in-home prophylaxis may translate into substantial cost savings for health care purchasers.