Managed Care - November 2008 - (Page RSV7)

In the Trenches: A Pediatrician’s Perspective on Prevention and Treatment Strategies for RSV Disease MICHAEL P. FROGEL, MD Associate Professor of Pediatrics, Albert Einstein College of Medicine, New York City Chief, General Pediatrics and Sports Medicine, and Director of the Urgi-Center, Schneider Children’s Hospital, North Shore Long Island Jewish Health System, New Hyde Park, N.Y. Respiratory syncytial virus (RSV) bronchiolitis is the leading cause of hospitalization of infants younger than 1 year (Figure). Between 1980 and 1996, the rate of hospitalization for bronchiolitis in children younger than 6 months increased 2.4-fold (Shay 1999). More recent estimates place the rate of RSV hospitalization in infants younger than 1 year at 24.3 per 1,000, with annual RSV hospital costs exceeding $1.1 billion (McLaurin 2005). Palivizumab (Synagis) is a U.S. Food and Drug Administration-approved monoclonal antibody that is administered intramuscularly to prevent severe RSV disease in high-risk infants. Although timely immunoprophylaxis with palivizumab can reduce RSV hospitalizations and morbidity in high-risk populations, pediatricians who provide immunoprophylaxis face numerous challenges, such as reimbursement obstacles and achieving continuity of care. In this article, I discuss those challenges from the perspective of a practicing pediatrician at a children’s hospital. Premature infants at high risk Children at high risk of RSV disease include infants born prematurely; children with chronic lung disease (CLD), also known as bronchopulmonary dysplasia (BPD); and children with hemodynamically significant congenital heart disease (CHD). There remains significant controversy concerning the appropriate criteria and need for immunoprophylaxis with palivizumab for premature infants born after 32 weeks gestational age (GA). Among premature infants, the severity of RSV infection intuitively would be greater in those born with a GA of 32 weeks or less; however, some data indicate that the severity of illness during hospitalization appears to be at FIGURE RSV is the leading cause of hospitalization of infants aged 1 year or younger 40 Hospitalization rate per 1,000 children 35 30 25 20 15 10 5 0 1997 1998 1999 2000 2001 2002 RSV hospitalization rate Bronchitis (unspecified) hospitalization rate Pneumonia (unspecified) hospitalization rate Respiratory syncytial virus (RSV) Bronchitis (unspecified) Pneumonia (unspecified) 160,000 140,000 Number of hospitalizations 120,000 100,000 80,000 60,000 40,000 20,000 0 Source: McLaurin 2005 SUPPLEMENT / RSV 7

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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