Biotechnology Healthcare - July/August 2008 - (Page CB6)

Local RSV Virology Data Is Key To A Successful Immunoprophylaxis Program A managed care analysis by Barry S. Lachman, MD, MPH Medical Director, Parkland Community Health Plan, Dallas, Texas S The best systems use ambulatory uccessful intervention by samples that include office-based MCOs and clinicians for the community sites. Using only hospiprevention and managetalized patients or emerment of RSV disease gency room samples will depends on a number of elevate the results, skewing factors. Understanding the length of the season RSV epidemiology both in and both the beginning the population served and and end points. in the community are key Several strategies can be factors in developing a used to determine the population-based Barry S. Lachman, beginning and end points approach to immunopro- MD, MPH to an RSV season. Waiting phylaxis. Understanding to reach a threshold to begin the how local data are collected is key season can be a costly mistake, in successfully using that data to since the rise of incidence is often develop an RSV management rapid after the threshold. Further, strategy. Results of RSV detection techniques will vary, depending on compiling, disseminating, and taking action on results takes valuable the population that is sampled. time. A more productive strategy would be to set an onset point based on historic data and to be prepared to move it back if the threshold is reached early. End points can be more flexible if local data are quickly and readily available. The end point can be more easily extended or even contracted, based on local data. Development of a limited administration network that still provides access will facilitate the process of responding quickly to the surveillance data. The need for local response poses challenges for MCOs that are more centralized in setting guidelines. RSV coverage policies. Local virology data can also be used to further refine those policies to achieve maximum value and protection of infants and children covered by the policies. Clinicians, too, should use local data, in addition to historical RSV seasonal data, to ascertain RSV activity in their respective communities so that appropriate immunoprophylaxis can begin before the epidemic level of >10 percent is reached. In this way, clinicians can help prevent severe RSV disease and better manage their patients to avoid unnecessary and costly hospitalization. Summary Substantial variations in RSV seasonality across the United States make it a challenge to predict the onset and duration of an RSV season from year to year and from locality to locality. Delaying immunoprophylaxis until RSV is widespread in a community places infants and children at risk of severe RSV disease. Local trends are more precise indicators of RSV outbreaks. SDI and CDC, through their Data Sharing Agreement, along with the RSVAlert surveillance program, provide local RSV virology data that can be used to augment historical data. These data can be used to guide RSV immunoprophylaxis prevention and management programs to avoid unnecessary and costly hospitalizations. References AAP (American Academy of Pediatrics). Respiratory syncytial virus. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red book: 2006 report of the committee on infectious diseases. 27th ed. Elk Grove Village:American Academy of Pediatrics; 2006:560–566. Bauman J, Eggleston M, Oquist N, Malinoski F. Respiratory syncytial virus: seasonal data for regions of Florida and implications for palivizumab. South Med J. 2007;100(7):669–676. Boyce TG, Mellen BG, Mitchel EF, et al. Rates of hospitalization for respiratory syncytial virus infection among children in Medicaid. J Pediatr. 2000;137(6):865–870. CDC (Centers for Disease Control and Prevention). Brief report: respiratory syncytial virus activity–United States, 2004-2005. MMWR Morb Mortal Wkly Rep. 2005;54(49):1259–1260. «www.cdc.gov/mmwr/preview/mmwrhtml/mm5449a3.htm». Accessed May 15, 2008. CDC (Centers for Disease Control and Prevention). Brief report: respiratory syncytial virus activity–United States, 2005-2006. MMWR Morb Mortal Wkly Rep. 2006;55(47):1277–1279. «www.cdc.gov/mmwr/preview/mmwrhtml/mm5547a5.htm». Accessed May 15, 2008. CDC (Centers for Disease Control and Prevention). Brief report: respiratory syncytial virus activity–United States, July 2006November 2007. MMWR Morb Mortal Wkly Rep. 2007;56(48):1263–1265. «www.cdc.gov/mmwr/preview/mmwrhtml/mm5648a3.htm». Accessed May 15, 2008. CDC (Centers for Disease Control and Prevention). National Respiratory and Enteric Virus Surveillance System (NREVSS). «www.cdc.gov/surveillance/nrevss/rsv-data.htm». Accessed May 15, 2008. Fergie J, Purcell K. Respiratory syncytial virus laboratory surveillance and hospitalization trends in South Texas. Pediatr Infect Dis J. 2007;26(11):S51–S54. 6 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5449a3.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5547a5.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5648a3.htm http://www.cdc.gov/surveillance/nrevss/rsv-data.htm

Table of Contents Feed for the Digital Edition of Biotechnology Healthcare - July/August 2008

Biotechnology Healthcare - July/August 2008 Openers Contents Editorial/David B. Nash, MD, MBA Drug Track Health Plan Confidential Rheumatoid Arthritis A Decade of Trial, Error, False Starts, and Hope What Path Will Comparative Effectiveness Research Take? RA Therapies in Development: A New Generation of Relief Assessing the Full Impact of RA on Employers and Payers Stem Cells: Health Insurance You Can Bank On Specialty Pharmacy Employer to Employer Personalized Medicine Trends Clinical Briefs

Biotechnology Healthcare - July/August 2008

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