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

OBJECTIVES: To evaluate and describe outcomes associated with a novel in- home administration program of respi- ratory syncytial virus (RSV) prophylaxis with palivizumab; to analyze health resource utilization and cost outcomes; and to assess parental satisfaction with in-home administration of prophy- laxis for high-risk children. DESIGN: Descriptive program evalua- tion. 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 ill- ness. Only one of the hospitalized infants required ICU admission. One- fourth of the patients experienced fever or ear infection; 43.2% devel- oped cold symptoms. In-home palivizumab prophylaxis has the potential for saving $214 per patient over drug administration and hospital- ization 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 administra- tion 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 med- ical 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.