[2003] [2646] The Importance of Synagis Compliance in Preventing Hospitalizations

Jan Berger, Leonard Fensterheim, Joan O'Rourke, Scott Reid, Julie Slezak. (Sponsored by Susan Berger) Clinical Quality & Support, Caremark Inc., Northbrook, IL; Analytics and Outcomes, Caremark Inc., Northbrook, IL; Specialty Pharmacy Services, Caremark Inc., Northbrook, IL.

BACKGROUND: Respiratory syncytial virus (RSV) is the most frequent cause of severe respiratory infections in infants and young children and is responsible for 75,000 to 125,000 hospitalizations each year in the United States.¹ The cost of RSV hospitalizations range from $6,910 to $7,149.² In 1998 Palivizumab (Synagis) was approved by the Federal Drug Administration and introduced as a method for decreasing the severity of RSV and therefore the rate of hospitalization. The cost of a treatment with Synagis can be substantial with a 5 dose season over $6,500.³
OBJECTIVE: To evaluate the effect of Synagis® therapy compliance on hospitalization rates.
DESIGN/METHODS: Participants were identified by Caremark, Inc as infants having received at least one dose of Synagis during the 2001/2002 RSV season defined as between September 1, 2001 and April 30, 2002. Synagis usage was analyzed for these participants based on pharmacy dispenses and follow-up phone contact to assure the prescribed dose of Synagis was administered. Participants who were discontinued from treatment due to factors such as change of insurance, or a medical decision during the season were excluded from the analysis. Physician and/or guardian reported respiratory related hospitalizations were collected over the phone during each monthly pharmacy order.
“General mean compliance”, defined as having on average fewer than or equal to 35 days between Synagis shipments was assessed. A chi-square analysis was performed to test whether there was a significant difference in hospitalization rates between the compliant and non-compliant groups.
RESULTS: 10,390 participants were assessed. 9,675 infants were compliant giving a general mean compliance rate of 93.1%. 158 infants were hospitalized during the season giving an overall hospitalization rate of 1.5%. The odds ratio for being hospitalized non-compliant versus compliant was found to be (2.2{95%CI 1.4,3.5})/corresponding χ2 (p<0.001). The compliant groups’ hospitalization rate was 1.4% versus 3.1% for the non-compliant group.
CONCLUSIONS: This analysis suggests that compliance with Synagis is protective of infant hospitalization. This is especially important given the high cost of Synagis treatment as well as the high cost of RSV hospitalizations.
1 Journal of Pediatrics, Dec2000 Boyce et al
2 Arch Pediatric and Adolescent Med, Vol 155 Jan 2001, Stang,P
3 First Data Bank AWP $1,311.56 per average dose.