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The Pediatric Forum |

Cost Estimates of Prophylaxis

Frank W. Moler, MD, MS
Arch Pediatr Adolesc Med. 2001;155(2):199-200. doi:10.1001/archpedi.155.2.199.
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The study by Stevens et al1 from the University of Rochester examines an important issue facing many pediatricians, neonatologists, and pulmonologists: the cost-effectiveness of immune globulin prophylaxis for respiratory syncytial virus (RSV) hospitalization. It is important in cost analyses for researchers, reviewers, and readers to carefully consider assumptions made since subsequent results may be strongly influenced by such assumptions. The authors carefully describe many of the cost assumptions made in this study. For example, effectiveness of immune globulin products in actual clinical practice was assumed to be equal to efficacy demonstrated in clinical trials, no drug wastage was assumed, overestimation of the true hospitalization rate for nonuniversity premature newborns was acknowledged, etc. The authors make 1 assumption that may not be justified, and should be clarified for readers since the resulting cost analyses would be strongly influenced. The issue is the assumed average weight of patients used in the RSV immune globulin (RSV-IGIV and palivizumab) cost analysis. In the prior RSV-IGIV and palivizumab randomized clinical trials, the mean weight of patients in control and treatment groups ranged from 4.5 to 4.9 kg2,3; however, in the Rochester report, a mean weight of 3.5 kg was assumed.1 Since the cost of prophylaxis of each patient is directly related to patient weight, this assumption would appear to result in a 30% to 40% underestimation of the actual "costs of prophylaxis" for all groups presented in Table 2 of the article. Additionally, the relationship of "cost to prevent 1 hospitalization" is not proportional to this value and would result in an even larger cost to prevent 1 hospitalization than presented in Table 3. Similar assumption effects on cost analyses have been noted previously, related to reduction in palivizumab doses required for adequate prophylaxis.4

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