Indirect Costs of Respiratory Syncytial Virus Hospitalizations: A Commentary

Abstract

98 Much controversy surrounds the choice of optimal candidates for the prophylaxis of respiratory syncytial virus (RSV) based on published cost-effective measurements. The measurement of indirect costs associated with chronic illness is increasingly being recognized as a critical portion in understanding total health-care costs. The addition of indirect cost information to current cost-effectiveness ratios can potentially alter the approval coverage for treatment by payer groups. RSV is a highly prevalent condition among children that can affect primary caregivers’ productivity. The aggregate cost of providing prophylaxis for infants at risk for RSV is substantial, but the economic consequences of lost and reduced productivity for caregivers of this population can also be sizable. RSV is the leading cause of childhood hospitalizations, costing the United States over $300 million [1]. Monthly prophylaxis using palivizumab (Synagis®) or RSV-IGIV (Respigam®) has proven effective in reducing the risk of RSV, RSV hospitalizations, and associated direct medical costs. Cost-effective analyses have left many employers and managed care groups challenged to find the optimal balance of providing prophylaxis to certain infant candidates. According to the American Academy of Pediatrics (AAP) policy statement on RSV, only certain infants with prematurity (gestational age) and/or other risk factors are recommended for prophylactic treatment for the prevention of RSV [2]. The policy statement states in its recommendations that “given the large number of patients born between 32 and 35 weeks and the cost of the drug, the use of palivizumab in this population should be reserved for those infants with additional risk factors until more data are available.” The cost benefit analyses supporting this recommendation suggest that both the cost and the logistics associated with prophylaxis for this subset of infants may outweigh the potential cost benefits. Many organizations have been modifying the AAP’s recommendations to create their own guideline criteria for determining prophylactic treatment for RSV almost exclusively based on direct medical and pharmacy costs [3]. An increasing number of organizations have begun to include indirect productivity costs in assessing the cost benefit of chronic conditions. This more inclusive method is viewed as an investment in human capital that promotes a healthier and more productive workforce. Additional information assessing the indirect costs associated with RSV hospitalizations can aid employer groups and managed care organizations in estimating the overall cost burden and better identifying candidates for prophylaxis. One such study attempting to address the issue surrounding lost time and out-of-pocket costs associated with RSV hospitalizations is presented in this issue of Value in Health by Leader et al. [4]. The study begins to address the addition of indirect costs for RSV prophylaxis treatment evaluation. The article sheds light on the time and out-of-pocket costs associated with RSV hospitalizations for specific cohorts of infants that have not received prophylaxis for RSV. Issues not addressed in this study include the actual lost time and costs directly related to missed work. The survey identified the time and out-ofpocket costs for the primary caregiver and up to four additional family members (or friends) who were affected by the infant’s hospitalization episode. These total costs for all the persons involved were used to estimate the societal burden associated with the hospitalizations.