Abstract 760 Health Services Research: Immunization Delivery II Platform, Tuesday, 5/4

Background. Respiratory syncytial virus immune globulin (RSV-IG) has been shown to reduce the incidence of RSV hospitalization. RSV-IG is administered to high risk infants in a bolus infusion monthly over the RSV season. The high cost and limited effectiveness of RSV-IG have generated guidelines for its use. Absent from these guidelines are estimates of the additional emotional and time costs of RSV-IG to the infant and family. These data are required for an accurate cost-benefit assessment of RSV-IG. Purpose. To document the extent to which families are emotionally distressed by RSV-IG treatment, the indirect financial costs they may incur and the association of parental reactions to satisfaction with care. Method. Parents of 100 infants who received at least 1 infusion with RSV-IG at Arkansas Children's Hospital during the 96-97 or 97-98 RSV seasons were eligible for study. Of those, 80 were interviewed by telephone. Results. Of infants who received RSV-IG 96% had chronic lung disease and 4% were immune deficient. Median gestational age was 26 weeks. Infants received an average of 2.7 (s.d.=1.5) infusions. Almost a third did not complete monthly prophylaxis and were therefore unprotected during part of the RSV season. Fourteen infants (14%) were hospitalized with RSV. Following statistical exclusion of 2 outliers, median charge for RSV hospitalization was $9,795. Half of parents witnessed the baby in distress (some or much) during infusion, a third felt that the baby experienced pain (some or much), and a third reported that the baby responded to infusion with a high pitched or full cry. Over half (61%) of parents were somewhat or very upset by observing the needle stick, 36% were somewhat or very upset by seeing the baby held down, and 27% of parents cried during the procedure. Three quarters of parents observed multiple needle insertions and 22% observed infusion in the scalp. Baby and parental distress were negatively associated (p < 05) with parent satisfaction with care. A quarter of parents took time off work for RSV-IG treatment. Parental time costs were negatively associated (p < .01) with satisfaction. Despite significant emotional and time costs, 85% of parents reported that they would have their baby treated with RSV-IG again. Conclusions. Emotional and time costs should be considered in cost-benefit analyses of controversial health care practices like RSV-IG prophylaxis. Parental devotion to the vulnerable infant exceeded the considerable direct and hidden costs observed in this study. The new monoclonal antibody, palvizumab, may avoid many of the emotional and time costs associated with RSV-IG.