A cost-benefit analysis of RSV prophylaxis in high-risk infants.

OBJECTIVE: To determine the cost and benefit of using RSV-IG and palivizumab as prophylactic therapy against respiratory syncytial virus (RSV)-associated illness in high-risk infants. METHODS: A nonrandomized, retrospective, cohort control study was conducted comparing the outcomes of patients who received either RSV-IG or palivizumab therapy against RSV during the 1998-1999 RSV season with patients identified from the 1994-1995 RSV season who would have been eligible to receive prophylaxis had either agent been available at that time. Medical record reviews were conducted to gather data regarding the costs associated with both the administration of the prophylactic drugs and the treatment of RSV-associated hospitalizations in both groups. Decision analysis was used to determine the average cost per patient for both groups. A cost-benefit analysis was then conducted to determine the return on investment, if any, for the use of these drugs. A sensitivity analysis was also conducted to determine the robustness of the data. RESULTS: Patients who received RSV-IG or palivizumab had a hospitalization rate of 1.6% compared with 25% for the group who did not receive prophylactic drugs. The average costs for the RSV prophylaxis group were less per patient $3,733 compared with $4,258 in the group who did not receive prophylaxis. The benefit is a 23.4% lower chance of hospitalization for each infant or, in dollar figures, $3,985 ($17,031 x 0.234). The benefit-cost ratio is 1.15:1 ($3,985:3,461). The benefits, therefore, exceed the costs associated with the prophylaxis program. The prophylaxis program saved healthcare dollars by preventing RSV-related hospital-izations. CONCLUSIONS: Results demonstrate that when used according to our institution's criteria, RSV prophylaxis is of benefit to our institution.

Medication use evaluation: a work in progress.

The medication use evaluation (MUE) Program at the University of Iowa Hospitals and Clinics (UIHC) is a dynamic program that is constantly changing to meet the needs of this tertiary care institution. This article will provide an overview of the MUE process at UIHC as well as provide an example of a long-standing initiative that has evolved significantly since its inception in 1993. Examples of four other initiatives also will be provided to demonstrate the scope of this program. The examples to be covered in this article include: 5-HT3 receptor antagonists, alteplase, automatic substitution of cefotaxime, proton pump inhibitors, and COX-2 selective agents.