Oral Ribavirin Is a Cost-Effective Alternative to Intravenous Ribavirin for Respiratory Syncytial Virus (RSV) Infection after Lung Transplantation (LTx)

Abstract

Purpose RSV infection causes serious allograft dysfunction in LTx recipients. There is no proven effective therapy. We report the use of oral ribavirin for RSV after LTx, and evaluate its cost-effectiveness and impact on length of hospital stay. Methods and Materials Single center retrospective analysis of 23 consecutive LTx patients with RSV December 2011-August 2012. Diagnosis was confirmed by positive RSV PCR from nasopharyngeal swabs and /or bronchoalveolar lavage. Results 23 patients (12 male), aged 20-64, had symptomatic RSV presenting with cough, increased sputum production, nasal congestion, dyspnoea and a fall in home measured lung function. Mean FEV 1 fell from baseline 2.3±0.6 (1.2-3.3L) to 2.0±0.7 (1.0-3.3L) ( p p =0.046). Mean FEV 1 recovered to 2.2±0.7 (1.0-3.2L) at cessation of therapy and to 2.3±0.7 (1.2-3.1L) within 3 months. There were 2 late deaths. Compared with historical control subjects managed with IV ribavirin, mean drug cost saving was US$6703 per patient episode and mean inpatient bed days reduced by 7.6 days per admission. Conclusions Oral ribavirin appears to be an effective alternative to IV ribavirin in the treatment of RSV infection after LTx and provides considerable drug cost savings and reduction in length of hospital stay. Potential long term benefits on the development of chronic lung allograft dysfunction are yet to be determined.